Early Pre/Post Fluoro-Deoxyglucose Positive Emission Tomography (PET) Does Not Predict Outcome of Patients Undergoing Hematopoietic Stem Cell Transplantation in Hodgkins Disease and Non-Hodgkins Lymphoma.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2180-2180
Author(s):  
Jeanne Palmer ◽  
Timothy Goggins ◽  
Gloria Broadwater ◽  
Nelson J. Chao ◽  
John Chute ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Fdg Pet ◽  
Pet Scan ◽  
Cell Transplant ◽  
Hodgkins Lymphoma ◽  
Radiology Reports ◽  
Fdg Pet Scan ◽  
Pet Scans

Abstract This study was designed to investigate the predictive value of early pre/post stem cell transplant (SCT) FDG-PET on outcomes in non hodgkins (NHL) or Hodgkins lymphoma (HL). We analyzed patients who received SCT for treatment of relapsed or refractory NHL or HL at Duke Medical Center between the years of 1996–2007. Patients who had either a FDG-PET scan following salvage chemo- or radio- therapy and within 14 weeks of transplantation (pre-PET)or a FDG PET scan within 6–14 weeks following transplantation (post-PET) were included in the analysis. PET was determined to be positive or negative based on chart review of radiology reports. Survival times are estimated using Kaplan- Meier method. Hazard ratios (HR) are from univariate Cox proportional hazards models. Overall survival (OS) was measured from the time of transplant until death, and for those patients still alive, it was censored at the last follow up date. Disease free survival (DFS) was measured from the time of transplant until first progression or death, whichever occurred first, and was censored at the date of last follow up for those alive without progression. A total of 102 patients were identified with PET in the appropriate time period. Median age was 48.5 (18–78); 71 patients had NHL, 31 patients had HL. Ninety-eight (96%) of the patients had chemosensitive disease, and had a documented PR (62) or CR (36) prior to transplant. The median DFS and OS of this population was 55 and 73 mo respectively. Median time to follow up was 38 mo (1.5 – 145 mo). Of the 75 pre-PET scans, 32 (43%) were positive; of the 78 post-PET scans, 22 (28%) were positive. At the time of this analysis, 28 (27%) of the patients had died from disease progression. There were 8 (10.6%) pre-PET, and 7 (9%) post- PET readings that were not clear. Our analysis revealed that neither pre-PET nor post-PET results were predictive of DFS (HR 1.73 p=0.16, HR 1.97 p = 0.052) or OS (HR 1.92 p=0.13; HR1.65 p=0.21). Further, for the patients who had measurable disease at the entry to SCT, post-PET was not predictive for DFS (HR 1.62, p=0.29) or OS (HR 1.59 p=0.35). Exclusion of unclear PET readings did not have any effect on these results. In subset analysis, post- PET did predict DFS in patients with NHL (HR 2.6 p=0.034). Our results suggest that early pre/post SCT PET analysis is not beneficial in this algorithm for predicting overall survival in these patients. Negative post-PET may predict DFS in patients with aggressive NHL, however, did not predict OS in this group. Our analysis indicates that other methods of determining risk of relapse and transplant outcome are needed.

Preliminary Results of FDG-PET Scanning after GDP Chemotherapy Prior to Autologous Stem Cell Transplant (ASCT) for Relapsed/Refractory (RR) Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4645-4645
Author(s):  
Matthew D. Cooper ◽  
Umberto Falcone ◽  
Naom Tau ◽  
Eshetu G Atenafu ◽  
Richard Tsang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Fdg Pet ◽  
Pet Scan ◽  
Ct Scans ◽  
Pet Ct ◽  
Significant Difference ◽  
Additional Chemotherapy ◽  
Pet Scans ◽  
Additional Therapy

Abstract Introduction: Gemcitabine, dexamethasone and cisplatin (GDP) has become a standard salvage chemotherapy (SC) regimen for relapsed/refractory (RR) lymphoma prior to autologous stem cell transplantation (ASCT) (Crump JCO 2014). Response to SC is now evaluated using 18-Fluoro-deoxyglucose positron-emission-tomography (FDG-PET) scans based on the recent Lugano classification (Cheson JCO 2014). We evaluated the response of patients (pts) with Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (NHL) to GDP by PET-CT scans and attempted to determine whether PET was predictive of outcome. Methods: We performed a retrospective chart review of consecutive HL and DLBCL (diffuse large B-cell lymphoma) pts who underwent ASCT following GDP SC at our centre between January 2014 and July 2016. All pts previously received anthracycline-based chemotherapy (typically ABVD for HL or R-CHOP for NHL) for primary treatment. Pts underwent FDG-PET scans after 3 cycles of SC and scans were retrospectively reported with the Deauville Criteria Scale with Deauville scores of 1-3 considered negative, whereas scores of 4 or 5 represented a positive result. Response to GDP was documented with CT scans using 1999 Working group Criteria (JCO 1999). Pts proceeded to ASCT if they had a PR by CT imaging and no signs of PD on PET-CT. Post-PET radiation or additional chemotherapy could be given at the discretion of the treating physician. Progression free survival (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method from the date of progression or date of ASCT. Statistical analysis to determine the significance of PET result on outcome was performed using the long rank test. Results: 45 pts with DLBCL and 29 pts with HL were identified: median age was 45 (range: 23-69) and 29 (range: 19-58) years respectively. Baseline patient characteristics are listed in Table 1. Following GDP SC, PET Deauville scores of 1-3 were reported in 55% of HL and 29% of DLBCL pts. Overall response rate to GDP by CT was 72% for HL pts and 64% for DLBCL pts (Table 2). For HL, 100% (16/16) of pts with a PET(-) scan and 91% (10/11) with a PET(+) result proceeded to ASCT. 85% (11/13) of DLBCL pts who had a PET(-) scan and 48% (15/31) with a PET(+) scan underwent ASCT. Additional therapy post PET scan included involved field radiation, additional chemotherapy (mini-BEAM) or novel therapy (brentuximab and bendamustine for HL patients). Median follow-up time was 14.2 months (HL) and 13.4 months (DLBCL) from relapse/progression after initial chemotherapy; and 9.6 months (HL) and 10.9 months (DLBCL) from ASCT. There was a statistically significant difference between PET(+) and PET(-) DLBCL patients from the time of initial disease progression for PFS (26% versus 69%, p=0.011) that did not reach statistical significance for OS (p=0.072). However, there was no significant difference for PFS and OS in DLCBL from ASCT when stratified by PET result (p= 0.154 and p=0.723 respectively). In HL pts, no statistically significant differences for PFS and OS from progression (p=0.480 and p=0.387 respectively) or from ASCT (p=0.579 and p=0.450 respectively) were found when stratified by PET result (see Tables 3 and 4). Conclusion: Deauville 4-5 PET scores appear to be predictive of PFS for RR-DLBCL pts. The lack of a significant difference between PET results for OS in DLBCL is likely due to sample size and the need for longer follow-up. For RR-HL pts, PFS and OS rates were both high but did not seem to noticeably differ by PET result. Additional therapy employed for Deauville 4-5 patients peri-ASCT could influence outcome. Overall, PET response assessment post GDP appears to stratify outcome in patients with DLBCL and PET adapted therapy in HL patients may improve outcome in Deauville 4-5 patients. Review of pending cases and subsequent follow-up is ongoing. Disclosures No relevant conflicts of interest to declare.

Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) Performed after Two Cycles of Standard Chemotherapy (CT) on Treatment Outcome in Hodgkin Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 310-310
Author(s):  
Andrea Gallamini ◽  
Luigi Rigacci ◽  
Francesco Merli ◽  
Pasquale Errico ◽  
Alessandro Levis ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Predictive Value ◽  
Fdg Pet ◽  
Pet Scan ◽  
Prognostic Role ◽  
Fdg Pet Scan ◽  
The Mean ◽  
Pet Scans

Abstract Objectives: Several prognostic models based on simple clinical variables have been proposed for Hodgkin’s Disease (HD); however, when applied in a prospective way, they showed unsatisfactory predictive value and scarce reproducibility. The prognostic role of early evaluation of treatment response by TC or Gallium scan has been proved in the past. We report here the preliminary results of a clinical trial on the prognostic role of FDG PET scan performed very early during treatment in advanced stage HD patients (pts), treated by conventional, standard-dose, CT. Matherials and methods: Starting from january 2002, 55 new HD pts were consecutively enrolled into the trial; 42 completed the program and are valuable for the analysis. Pts characteristics were: mean age 34.9 years (16-79), advanced disease (stages IIB-IVB) in 24, and stage IIA in 18. Bulky and extra-nodal disease were recorded in in 12 and 11 pts, respectively. Histopathology was: NS in 36, LP in 3, MC in 2 and LD in 1. All pts were staged at baseline with TC scan, bone marrow trephine biopsy and FDG PET scan (PET-0); they were re-staged after 2 CT courses and at the end of the treatment, including radiotherapy, by TC scan and PET scan (TC-2, PET-2 and TC-8, PET-8, respectively). Standardized Uptake Value (SUV) was calculated in all FDG PET scans. PET-0 and PET-8 were considerate positive when the SUV value was ≥ 3 and PET-2 when the SUV ratio PET-2/PET 0 was > 33%. CT was ABVD in 36 pts, escalated BEACOPP in 5 and MOPP/EBV/CAD in 1. In 19/42 additional radiotherapy was given. The mean interval between the end of the 2nd CT course and PET-2 was 11.5 days (6-32); the interval between the end of the therapy (either CT or radiotherapy) and PET-8 was never shorter than 50 days. Results: The mean follow-up from the final restaging was 328.7 days (11-690). Mean SUV value of PET-0 was 12.04. At the end of the program 38 pts were in CR and 4 in progression; one relapsed 13 months after CR entry. TC-2 showed PR in 37 pts and CR in 5. By contrast, PET-2 was positive in only 5 pts: two of them, with a mean SUV-2/SUV-0 ratio of 26.5% (20-33), showed a progressive reduction of SUV in subsequent PET scans, up to a complete negativity: both are in continuous CR. Two out of three pts with a mean SUV reduction to 61% (49-85) of the basal values progressed after the 5th and the 8th CT course, respectively; the third relapsed in CR one year after CT completion. 34/37 (92%) pts with a negative PET-2 showed a PET-8 persistently negative and remained in CR; 2 progressed during CT and one relapsed 12 months after the end of the therapy. Upon assuming that a PET-2 is positive when the ratio of SUV-2/SUV-0 is >33%, the Predictive Positive Value (PPV) of a PET-2 was 100% and the Predictive Negative Value (PNV) was 92%. The sensitivity of PET-2 was 50%, the specificity was 100% and the overall accuracy 93%. Conclusions: The FDG PET scan performed very early during therapy predicts the treatment outcome in most pts. (39/42: 93%), with a PPV value of 100% and a PNV value of 92%. However, since most relapses of HD occur within 24 months from diagnosis, definite conclusions will be drawn after a minimum follow-up of two years.

PET scan as a prognostic marker in advanced colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 442-442
Author(s):  
Sri Lakshmi S. Kollepara ◽  
Minsig Choi ◽  
Lance K. Heilbrun ◽  
Daryn W. Smith ◽  
Anthony Frank Shields ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Post Treatment ◽  
Pet Scan ◽  
Fdg Pet Scan ◽  
Study Population ◽  
Pet Scans

442 Background: Clinical utility and ability to prognosticate using FDG-PET scan in metastatic colorectal cancer (mCRC) has not been well studied in previous literature. We hypothesized that standardized uptake value (SUV) in post treatment FDG-PET predicts clinical outcomes. Methods: We retrospectively reviewed mCRC patients who had pre and post treatment FDG - PET scans during 2005-2012 at Karmanos Cancer Institute. Primary end points of time to progression (TTP) and overall survival (OS) were compared between the two groups (follow up SUV = 0 vs. SUV > 0) using log-rank testing. Results: Study population consisted of 44 patients (median age of 58.1 years). Forty (91%) of these patients were treated first line and 34 (77 %) received an Oxaliplatin based regimen. Forty-one patients had both pre- and a post-treatment SUV. The 12 patients with post treatment SUV= 0 and the 29 patients with post-treatment SUV > 0 had median OS of 42 and 25.2 months, respectively; they had median TTP of 8.2 and 6.9 months, respectively. The patients with post treatment SUV= 0 had significantly longer OS (p = 0.0310) and weakly significantly longer TTP (p = 0.0628) compared to the patients with post-treatment SUV > 0. Conclusions: Systemic therapy decreased SUV on follow-up PET scans in the study population. Absence of FDG uptake on follow up PET scan was associated with longer OS and was suggestive of longer TTP in patients with metastatic colorectal cancer.

scholarly journals Normalization of pre-ASCT, FDG-PET imaging with second-line, non–cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma

Blood ◽  
2012 ◽  
Vol 119 (7) ◽  
pp. 1665-1670 ◽  
Author(s):  
Craig H. Moskowitz ◽  
Matt J. Matasar ◽  
Andrew D. Zelenetz ◽  
Stephen D. Nimer ◽  
John Gerecitano ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Autologous Stem Cell Transplant ◽  
Salvage Chemotherapy ◽  
Pet Scan ◽  
High Dose ◽  
Cell Transplant ◽  
18Fdg Pet ◽  
Fdg Pet Scan ◽  
Intent To Treat

Abstract We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) 18FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70% and 79%, respectively. Patients transplanted with negative FDG-PET, pre-HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80%, versus 28.6% for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT. The study was registered at www.clinicaltrials.gov as NCT00255723.

scholarly journals Risk-Adapted Dose-Dense Immunochemotherapy Determined by Interim FDG-PET in Advanced-Stage Diffuse Large B-Cell Lymphoma

2010 ◽  
Vol 28 (11) ◽  
pp. 1896-1903 ◽  
Author(s):  
Craig H. Moskowitz ◽  
Heiko Schöder ◽  
Julie Teruya-Feldstein ◽  
Camelia Sima ◽  
Alexia Iasonos ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Pet Scan ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Positive Biopsy ◽  
Fdg Pet Scan ◽  
Dose Dense ◽  
Pet Scans

Purpose In studies of diffuse large B-cell lymphoma, positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. Patients and Methods From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. Results At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET–positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET–positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). Conclusion Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.

FDG PET Scan Alone Better Predicts Progression Free Survival at 2 Years Compared to CT Imaging in Aggressive Histology Non-Hodgkin’s Lymphoma Following Initial Anthracycline-Based Chemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3299-3299 ◽  
Author(s):  
Gregory A. Wiseman ◽  
Malik E. Juweid ◽  
Eric M. Rohren ◽  
James E. Wooldridge ◽  
Michael M. Graham
Keyword(s):  
Bone Marrow ◽  
Tumor Cells ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Ct Imaging ◽  
Pet Scan ◽  
Predictive Values ◽  
Viable Tumor ◽  
Fdg Pet Scan ◽  
Pet Scans

Abstract Background: CT imaging has routinely been used for assessing therapy response in most malignancies including Non-Hodgkins Lymphoma (NHL). The presence of residual tumor is generally categorized using the International Workshop Criteria from CT imaging and bone marrow biopsies for assessing response after treatment. CT imaging has limitations in assessment of response to therapy in NHL with false positive results due to residual masses having viable tumor cells in less than 20% and the remainder being fibrosis or necrosis. In addition false negative CT results are seen due to viable tumor cells in nodes measuring less than 1.5 cm in size. F-18 FDG PET scans provide metabolic imaging of viable tumor cells due to uptake and retention of F-18 fluorodeoxyglucose preferentially in malignant cells. Method: Forty-eight patients with aggressive NHL having completed anthracycline-based chemotherapy had the post therapy FDG PET scans and CT scans reviewed by experienced readers blinded from the comparison scan and from the clinical history. PET scans were read as positive or negative for abnormal FDG consistent with residual viable tumor and the CT was read as positive or negative for nodes greater than 1.5 cm in diameter. Records were reviewed for tumor histology and evidence of tumor relapse with a median follow-up of 35 months. Results: The FDG PET and CT imaging prediction of PFS at 2 years had positive predictive values of 67% and 38%, negative predictive values of 88% and 78%, and accuracy of 81% and 50% respectively. The sensitivity and specificity of the FDG PET scan was 71% and 82% for predicting disease progression within 2 years from beginning treatment. Conclusion: FDG PET imaging was compared with CT imaging done after completing initial chemotherapy for aggressive NHL and demonstrated superior prediction of tumor response status at 2 years. These results indicate that FDG PET imaging should be combined with bone marrow biopsy for restaging aggressive NHL after completion of chemotherapy. The use of FDG PET is more accurate and should replace response assessment by CT imaging in most pateints with aggressive NHL following treatment.

Improved Survival for Patients Undergoing Autologous Stem Cell Transplant for Primary CNS Lymphoma in First or Later Remission.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1222-1222 ◽  
Author(s):  
Patrick B Johnston ◽  
Ivana N Micallef ◽  
Stephen M Ansell ◽  
David J Inwards ◽  
Luis F. Porrata ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Primary Cns Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Cns Lymphoma ◽  
Cell Transplant ◽  
Additional Therapy

Abstract Abstract 1222 Poster Board I-244 Background Survival for patients with primary CNS lymphoma (PCNSL), in general, is poor with patients requiring frequent chemotherapy treatments or receiving whole-brain radiation therapy, which can potentially result in significant neurologic decline and dementia. Because of the improved survival of high risk patients with aggressive lymphoma undergoing autologous stem cell transplant (ASCT), we began ASCT for patients with PCNSL in first or later remission with chemotherapy sensitive disease. We now update on outcomes of patients who have had at least 100 day follow up post ASCT. Baseline characteristics Between June, 2000 and January, 2009, 22 patients underwent ASCT for PCNSL. Median age at transplant was 50 years old (range 26-67). Median number of prior treatments 1 (range 1-3). Median time from diagnosis to transplant was 7.2 months (range 2.9 to 75.8). Median International Extranodal Working Study Group Prognostic Score: 2 (range 0-3). Disease status at transplant: First CR 10 patients, later CR or PR 12 patients. Results Twenty-two patients underwent ASCT for PCNSL and have a minimum of 100 days follow-up. All patients received BEAM conditioning. Median follow up post-transplant was 30 months (range 3-107 months). Eight patients have relapsed at a median of 217 days (range 40-1349). Of the patients who relapsed, four have died of disease progression and the remaining four are alive after additional therapy. Median overall survival from diagnosis or transplant has not been reached. Median progression free survival from transplant was 70 months. Conclusions Although limited by patient selection and retrospective biases, this review suggests that ASCT for PCNSL demonstrates improved overall survival when compared to historical controls with similar PCNSL Prognostic Scores (2 year survival for patients from diagnosis with PS 2-3 was 48% in a prior published study). ASCT in first remission in patients with PCNSL appears promising and may limit the need for additional therapy which can be myelosuppressive or result in neurologic decline secondary to radiation therapy in patients who are appropriate candidates. Disclosures No relevant conflicts of interest to declare.

Normalization of FDG-PET Pre-ASCT with Additional Non-Cross Resistant Chemotherapy Improves EFS in Patients with Relapsed and Primary Refractory Hodgkin Lymphoma-Memorial Sloan Kettering Protocol 04-047

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 775-775 ◽  
Author(s):  
Craig H. Moskowitz ◽  
Stephen D. Nimer ◽  
Andrew D. Zelenetz ◽  
Paul A. Hamlin ◽  
Steven M. Horwitz ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Standard Dose ◽  
High Dose Chemotherapy ◽  
Pet Scan ◽  
High Dose ◽  
Remission Duration ◽  
Fdg Pet Scan ◽  
Extranodal Disease ◽  
Involved Field

Abstract We have reported that outcome of transplant-eligible patients (pts) with relapsed and primary refractory HL is determined by three pre-second-line chemotherapy (ST) risk factors (RF): remission duration of <1 yr., extranodal disease and B symptoms. In addition, normalization of FDG-PET prior to ASCT is the most important factor predicting favorable EFS. We now report the preliminary results of an ongoing phase II risk-adapted study where HL pts receive the following: Favorable risk (0–1 RF) - one cycle of standard dose ifosfamide, carboplatin and etoposide (ICE) ST followed by one cycle of augmented ICE; unfavorable risk (2-RF)- 2 cycles of augmented ICE. All pts then underwent a restaging FDG-PET and the results determined the next treatment. Pts with a negative FDG-PET went directly to HDT/ASCT; however if the FDG-PET was still positive, pts received an additional four biweekly cycles of gemcitabine (1000 mg/m2), vinorelbine (20 mg/m2) and liposomal doxorubicin (15 mg/m2) (GVD) followed by repeat FDG-PET scan; pts without evidence of progression then received HDT/ASCT. Preceding high-dose chemotherapy and ASCT, patients that were radiation therapy-naive received involved field radiotherapy (IFRT) followed by total lymphoid irradiation. Selected previously irradiated patients received only IFRT. Sixty-two pts are evaluable; median follow-up of surviving pts is 30 months; median age was 35. Forty-eight pts had a remission duration of < 1 yr. of those, 28 had primary refractory disease; 28 had extranodal disease and 11 had B symptoms. All patients had previously failed doxorubicin-based chemotherapy; 18 had received prior radiation; of those, 13 failed in the radiation field. Following first ST chemotherapy with ICE, 3 pts progressed, while 37 pts normalized their FDG-PET scan and currently 31 of these pts are event-free. Twenty-five pts with an improving CT scan after ICE still had a persistently positive FDG-PET; they received the second ST with GVD. Of these, 13 pts normalized their FDG-PET scan and 11 are eventfree; the remaining 12 pts had persistently abnormal FDG-PET scan or progressed; only 4 of them are event-free. There was no difference in outcome between the pts who had normal FDG-PET after ICE (pre-ASCT) and those who achieved a negative FDG-PET scan because of the additional ST with GVD. Both of these cohorts had a statistically significant improvement in EFS compared to pts with a persistently positive FDG-PET. In total 46/62 (65%) pts on this program are currently event-free. One pt died from sepsis. Conclusion: For pts with relapsed and primary refractory HL our evolving strategy is to administer ST until normalization of FDG-PET is achieved prior to HDT/ASCT. Figure Figure

Tandem Autologous Stem Cell Transplantation in Chemorefractory Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4554-4554
Author(s):  
Catherine Garnett ◽  
Chrissy Giles ◽  
Osman Ahmed ◽  
Maialen Lasa ◽  
Holger W. Auner ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Stem Cell Transplant ◽  
Progression Free Survival ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Free Survival

Abstract Abstract 4554 High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is currently standard treatment for younger patients with multiple myeloma, resulting in improved survival and response rate compared to conventional chemotherapy. Disease relapse, however, remains almost inevitable and thus the role of two successive (tandem) autologous stem cell transplants has been evaluated in chemorefractory patients as a means of prolonging duration of disease response. We retrospectively analysed the results of nine patients with chemorefractory disease treated at a single UK institution who received tandem ASCT between January 1998 and February 2009. There were six men and three women. Median age at diagnosis was 56 years (range, 42–65 years). Paraprotein isotype was IgG in eight patients and IgA in one patient. Median serum paraprotein level was 41g/L (range 12–73g/L) at presentation. At time of 1st transplant six patients were in stable disease (SD) and three had evidence of progressive disease. Conditioning melphalan dose was 140mg/m2 in all but two patients who received 110mg/m2 and 200mg/m2. Median time between transplants was 3.7 months (range 2.3–6.4 months) with PR and SD being observed in 2/9 and 7/9 patients at time of 2nd transplant. None of the patients reached complete response (CR). One patient received melphalan 140mg/m2 prior to 2nd transplant. The remaining patients received melphalan 200mg/m2. Median follow up after tandem transplant was 54.3 months (range 15.6 –143.6 months). No treatment related mortality was reported. At the time of analysis, six patients were still alive and under follow up with an overall survival (OS) figure for the group of 52% at 10 years from diagnosis (Figure 1). Median progression free survival (PFS) was 20 months from 2nd transplant (range 6.7–62.6 months) (Figure 2). Tandem autologous stem cell transplant in chemorefractory patients has resulted in overall survival similar to autologous stem cell transplant in chemosensitive patients and should be considered in patients with chemorefractory disease. Figure 1: Overall survival from diagnosis in patients receiving tandem autologous stem cell transplant for multiple myeloma Figure 1:. Overall survival from diagnosis in patients receiving tandem autologous stem cell transplant for multiple myeloma Figure 2: Progression free survival following tandem transplant Figure 2:. Progression free survival following tandem transplant Disclosures: No relevant conflicts of interest to declare.

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