Salvage high-dose melphalan with autologous stem cell transplantation as bridge to consolidation therapy for chemoresistant aggressive B-cell lymphoma

Reversible late onset neutropenia associated with rituximab has been reported with incidence rates varying from 15 to 70% in B cell lymphoma patients receiving autologous stem cell transplantation. We conducted a retrospective descriptive study at one tertiary care center in adult B cell lymphoma patients treated with rituximab and autologous stem cell transplantation between 1 January 2004 and 30 June 2014. Late onset neutropenia was defined as an absolute neutrophil count <1.0 × 109 cells/L after neutrophil engraftment and less than six months post autologous stem cell transplantation. The primary objective was to determine the incidence of late onset neutropenia. The secondary objectives were to examine whether the use of rituximab with re-induction therapy, mobilization or high dose chemotherapy regimens increased the risk for late onset neutropenia, and to evaluate infectious complications. Of 315 subjects, 92 (29.2%) developed late onset neutropenia. Mobilization regimens containing rituximab (OR 2.90 95% CI: 1.31–6.40), high dose chemotherapy containing rituximab (OR 1.87 95% CI: 1.14–3.05), and exposure to rituximab in either or both regimens (OR 3.05 95% CI: 1.36–6.88) significantly increased the risk of late onset neutropenia. While neutropenic, 17.4% experienced an infection, 7.6% experienced febrile neutropenia, and 5.4% were hospitalized. In conclusion, rituximab with mobilization or high dose chemotherapy may increase the risk of late onset neutropenia post autologous stem cell transplantation.

Download Full-text

Safety and efficacy of high-dose ranimustine (MCNU) containing regimen followed by autologous stem cell transplantation for diffuse large B-cell lymphoma

International Journal of Hematology ◽

10.1007/s12185-018-2508-1 ◽

2018 ◽

Vol 108 (5) ◽

pp. 510-515 ◽

Cited By ~ 4

Author(s):

Yoshihiro Kameoka ◽

Tomoaki Akagi ◽

Kazunori Murai ◽

Hideyoshi Noji ◽

Yuichi Kato ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

B Cell ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose ◽

Safety And Efficacy ◽

Large B Cell Lymphoma ◽

Large B Cell

Download Full-text

Primary Mediastinal Large B-Cell Lymphoma: A Single Center Experience in Korea.

Blood ◽

10.1182/blood.v114.22.5013.5013 ◽

2009 ◽

Vol 114 (22) ◽

pp. 5013-5013

Author(s):

Heui June Ahn ◽

Yoo Jin Cho ◽

Myoung Joo Kang ◽

Dae Ro Choi ◽

Shin Kim ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

B Cell ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose Chemotherapy ◽

High Dose ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Abstract 5013 Introduction Primary mediastinal large B-cell lymphoma (PMBCL) was formally established as a distinct subtype of diffuse large B-cell lymphoma (DLBCL). Some studies indicated that patients with PMBCL have an aggressive clinical course with short median survival but more recent studies reported a relatively good response rate and survival. Therefore, controversies still exist regarding the response to therapy and prognosis of patients with PMBCL. Patients and methods Between July 1993 and July 2008, a total of 26 patients with PMBCL were identified at Asan Medical Center, Seoul Korea. We retrospectively reviewed the clinic-pathologic features and clinical outcomes of them in comparison with 597 patients diagnosed with non-mediastinal DLBCL during the same period. Result Out of the 26 patients, 17 (65.4%) were females and 9 (34.6%) males, while out of the 597 patients, 257 (43.0%) were females and 340 (57.0%) males (p=0.025). The median age of the PMBCL patients was 31.5 years old (range 15-78 years old), while that of the DLBCL patients was 56.0 years old (range 15-85 years old). Out of the 26 patients, 14 (53.8%) had a Ann Arbor stage III or IV disease, 7 (26.9%) had B symptoms, and by the IPI, 11 were in low, 9 in low intermediate, 2 in high-intermediate and 4 in high risk group. Out of 24 patients treated with front-line therapy CHOP or R-CHOP, 17 (70.8%) reached a CR, while 1 PR patient reached a CR after being treated with high-dose chemotherapy followed by autologous stem cell transplantation. Five refractory patients were treated with high-dose chemotherapy followed by autologous stem cell transplantation, but among them only one reached a CR and 4 died of disease progression. With a median follow-up of 41.5 months (range 1-92 months), 5-year survival rates of PMBCL and non-mediastinal DLBCL patients were 69% and 65.7%, respectively (p=0.982, Log Rank). Conclusion There was no difference between PMLBL and non-mediastinal DLBCL in terms of clinical features and outcomes. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Disease characteristics of diffuse large B-cell lymphoma predicting relapse after autologous stem cell transplantation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e19030 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e19030-e19030

Author(s):

Daria Gaut ◽

David Oveisi ◽

Grant Howell ◽

Tahmineh Romero ◽

Gary J. Schiller

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

B Cell ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose ◽

Large B Cell Lymphoma ◽

Large B Cell

e19030 Background: High-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) is standard of care for patients with diffuse large B-cell lymphoma (DLBCL) whose diseases relapse after, or are refractory to, first-line therapy. However, there are still high rates of relapse following ASCT, and non-relapse mortality also affects survival rates. Prognostic indicators are therefore needed to identify the best candidates for HDC/ASCT. Methods: We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed, 33 refractory) who underwent HDC/ASCT at the University of California Los Angeles from 2010-2015. Results: The median age at the time of ASCT was 61 years (IQR 51.5-68.0). 80 patients (72%) had DLBCL in a complete response at the time of ASCT, and the majority (98 patients, 88%) had ECOG performance status of 0-1. After a median follow-up of 4.6 years (IQR 2.2-8.1), the 1-year progression-free survival (PFS) rate was 77.3% (95% CI 69.7%-85.7%) and the 1-year overall survival (OS) rate was 84.7% (95% CI 78.2%-91.7%). 41 patients (37%) relapsed after ASCT with a median PFS of 11 months (IQR 5.0-20.0). 37 patients (33%) died, 23 (21%) from relapse mortality, 11 (10%) from non-relapse mortality, and 3 (3%) from unknown cause of death. In univariate analysis, 2 variables were significantly associated with curtailed PFS and OS: higher number (≥ 3 vs < 3) of chemotherapy regimens prior to ASCT (HR 2.20, 95% CI 1.19-4.06, p = 0.013 for PFS; HR 2.01, 95% CI 1.06-3.84, p = 0.036 for OS) and higher International Prognostic Index (IPI) score at time of ASCT (trend HR 1.61, 95% CI 1.10-2.35, p = 0.018 for PFS; trend HR 2.02, 95% CI 1.37-2.98, p = 0.001 for OS). Higher National Comprehensive Cancer Network (NCCN) IPI score at time of ASCT (trend HR 2.29, 95% CI 1.34-3.90, p = 0.002) and refractory versus relapsed disease (HR 1.99, 95% CI 1.04-3.82, p = 0.038) were also significantly associated with curtailed OS. Conclusions: Our study suggests that IPI, while a validated prognostic tool at diagnosis, is also a prognostic indicator at time of ASCT for PFS and OS. NCCN IPI at time of ASCT was also found to be predictive of OS. Age-adjusted IPI was not associated with outcome following ASCT.

Download Full-text