High-Dose Therapy and Autologous Stem Cell Transplant (HD-ASCT) for Transformed Non-Hodgkin Lymphoma (NHL) In the Rituximab Era

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2393-2393
Author(s):  
Makiko Ban-Hoefen ◽  
Jonathan W. Friedberg ◽  
Jennifer L. Kelly ◽  
Steven H. Bernstein ◽  
Jane L. Liesveld ◽  
...  
Keyword(s):  
Stem Cell ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Cell Transplant ◽  
Indolent Lymphoma ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy ◽  
Indolent Disease

Abstract Abstract 2393 Background: The transformation of indolent non-Hodgkin's lymphoma (NHL) to a more aggressive histology remains a therapeutic challenge. For younger patients with a favorable performance status, high-dose therapy and autologous stem cell transplantation (HD-ASCT) results in a prolonged progression-free survival (PFS) in a substantial subset, based upon retrospective single and multi-institutional experiences. Rituximab improves PFS and overall survival (OS) in both follicular and aggressive NHL when combined with chemotherapy. However, the impact of prior rituximab on outcome of HD-ASCT for transformed NHL has not been elucidated. Methods: We therefore analyzed consecutive patients with indolent NHL (including follicular lymphoma and marginal zone lymphoma) who developed histologically confirmed transformation to diffuse large B-cell lymphoma (DLBCL) and subsequently underwent HD-ASCT at the University of Rochester Medical Center between 1998 – 2009. Patients who transformed within 6 months of the diagnosis of indolent lymphoma were excluded from the study. Progression free survival (PFS) was defined as time from HD-ASCT to date of disease relapse, progression, or death due to any cause. Kaplan-Meier survival curves were estimated, and differences in PFS between those who received rituximab prior to transformation versus those who were rituximab-naïve at transformation were assessed using the log-rank test. Results: 19 patients were identified, (10 female) who received rituximab-containing therapy at transformation. The median age at HD-ASCT was 59 years (range 40–66). Patients were treated with a median of 3 (range 1–9) chemotherapy regimens prior to HD-ASCT. Median time from the diagnosis of indolent lymphoma to transformation was 55 months (range 8–276). Conditioning regimens at HD-ASCT were BEAM (N=15), BEAC (N=1) and Cy/TBI (N=3). With a median follow-up of 47 months, the 2-year PFS was 58% and the 2-year OS was 84%. There were no treatment-related mortalities. Seven patients relapsed after HD-ASCT (2 with indolent histologies and 5 with DLBCL); 3 of these patients have died. Two additional patients have died of myelodysplastic syndrome-acute myeloid leukemia after HD-ASCT. Eight patients did not receive rituximab for indolent disease prior to transformation; this group had a significantly better PFS at 2 years (86% vs 36%, p = 0.049) compared to 11 patients who were treated with rituximab for indolent disease prior to ASCT. The patients who did not receive rituxmiab prior to ASCT had similar characteristics to patients who received rituximab, except that the time from indolent diagnosis to transformation was longer in the rituximab-naïve group (90 months vs 39 months). Conclusions: HD-ASCT remains an effective therapeutic option for transformed NHL in the rituximab era. However, transformed patients exposed to rituximab prior to HD-ASCT appear to have inferior outcomes, similar to the experience of patients with de novo NHL treated with rituximab prior to HD-ASCT in the recently reported CORAL study (JCO, published online ahead of print July 26, 2010). Patients who transform after rituximab-containing therapy may represent a higher risk group of patients with a unique biology, who may benefit from novel conditioning and maintenance regimens in the setting of HD-ASCT. Disclosures: No relevant conflicts of interest to declare.

GDP (Gemcitabine, Dexamethasone, Cisplatin) Salvage Therapy Results in Superior Progression Free Survival Compared to Mini-Beam Prior to Autologous Stem Cell Transplantation for Relapsed or Refractory Hodgkin’s Lymphoma.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 905-905 ◽  
Author(s):  
John Kuruvilla ◽  
Tracy Nagy ◽  
Melania Pintilie ◽  
Armand Keating ◽  
Michael Crump
Keyword(s):  
Stem Cell ◽  
Salvage Therapy ◽  
Progression Free Survival ◽  
Salvage Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy ◽  
Cd34 Cells

Abstract Objectives: To compare the response rates and early progression free survival (PFS) after high-dose therapy and autologous stem cell support (ASCT), following salvage chemotherapy with either GDP (gemcitabine 1000 mg/m2 IV d1 & 8, dexamethasone 40 mg PO d1-4, cisplatin 75 mg/m2 day 1) q 3 weeks or mini-BEAM (MB: BCNU, etoposide, cytarabine, melphalan) q3-4 weeks in patients (pts) with relapsed or refractory Hodgkin’s lymphoma. Material and methods: Sixty-eight consecutive pts referred for salvage therapy (34 MB, 34 GDP) were retrospectively compared. All had received prior ABVD chemotherapy except for 3 GDP pts (one received MOPP, one Stanford V, one MOPP/ABV). MB administration required admission to hospital wherease GDP was given in the outpatient setting. Pts typically received 2 cycles of salvage therapy; responding patients had PBSCs mobilized with cyclophosphamide 2 g/m2 day 1, etoposide 200 mg/m2 days 1–3 and filgrastim 10μg/kg. PBSC collection commenced when the blood CD34 cell count was >5–10/μL. Target PBSC number was ≥5 x 106 CD34+ cells/kg and a minimum threshold of 2 x 106 CD34+ cells/kg was required to proceed to high dose therapy (etoposide 60 mg/kg day −4, melphalan160 mg/m2 day −3; PBSC infusion day 0). Pts with bulk disease at relapse > 5cm received involved field radiation (RT) post-ASCT (7/30 GDP pts and 7/28 MB pts). Results: The MB and GDP groups were similar in stage at relapse (limited stage 38% in each group) and disease status (primary refractory: MB 47%, GDP 53%). Ps receiving GDP were older (mean age 43y, range 19–64, vs. MB: mean 34, range 19–60), while more MB pts had previous RT (48% vs. 24%, p=0.03). There were slightly more male pts that received MB versus GDP (M:F MB 24:10, GDP 17:17). The response rate to GDP prior to ASCT (CR, CRu or PR) was 62% (95% CI: 45%–78%) vs. 68% for MB (95% CI: 52%–83%, p=0.61). Nine and 5 pts had stable disease, and 4 and 6 pts progressed on GDP and MB, respectively. 30/34 pts receiving GDP and 28/34 MB pts proceeded to PBSC mobilization. The proportion of pts who had PBSC collections > 2 x 106 CD34+ cells/kg was 97% after GDP vs. 82% after MB (p=0.07), and the proportion collected in a single apheresis procedure was 90% vs 57% (p=0.0043). The proportion of pts who reached the PBSC target of ≥ 5 x 106 CD34+ cells/kg was 97% after GDP and 57% after MB (p=0.0003), and was obtained in a single apheresis more often after GDP (73% vs 36%, p=0.004). Bone marrow harvest was needed in 1 GDP pt (3%) and 5 MB pts (18%, p=0.07). After a median follow up of 1.8 yrs post ASCT for all pts (GDP: 1.2 yrs, range 0.3 – 2.8 yrs; MB: 3 years, range 1.2 – 4.6 yrs), PFS is significantly better for pts receiving GDP compared to MB (74% vs. 35% at 1.5 years, p=0.005). Overall survival at 1.5 yrs is 91% for GDP pts and 82% for MB (p=0.23). Conclusions: Although this is a retrospective analysis, response to and early PFS post-ASCT after GDP compares favourably to MB salvage chemotherapy, our previous standard. Pts receiving GDP have higher PBSC yields, are more likely to have an optimal collection after a single leukapheresis and less likely to experience mobilization failure than pts receiving MB salvage. Based on these data, a phase III trial comparing GDP to MB or dexa-BEAM is warranted.

scholarly journals Prognostic Factors for Patients with Diffuse Large B Cell Lymphoma and Transformed Indolent Lymphoma Undergoing Autologous Stem Cell Transplantation in Denmark 2000-2012

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1983-1983
Author(s):  
Bente Arboe ◽  
Kristina Fruerlund Nielsen ◽  
Charlotte Madsen ◽  
Rasmus Heje Thomsen ◽  
Soeren Ramme Nielsen ◽  
...  
Keyword(s):  
Stem Cell ◽  
B Cell ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Refractory Disease ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Large B Cell

Abstract Introduction: Diffuse large B-cell lymphoma (DLBCL) is the largest subgroup of malignant lymphoma. Today more than 80% of the patients will achieve partial or complete remission. However more than 20 % will either relapse or present with refractory disease. The standard approach for patients without major comorbidity is salvage treatment followed by high dose therapy with autologous stem cell transplant (HDT). This potentially curative treatment is toxic with many side effects and procedure related mortality, and therefore identification of patients eligible for HDT is a difficult challenge. Objectives: Patients with relapse of de novo DLBCL and transformed indolent lymphoma (TIL) were included. The aim was to identify clinical prognostic markers that can identify patients who will not benefit from HDT. Methods: From the national lymphoma registry patients with relapse of B-cell lymphoma in Denmark in the period 2000-2012, who underwent HDT, were extracted. Medical records were reviewed for clinical, pathological, and treatment information, and outcome. Patients were followed until death or emigration or until February 1, 2015. The Kaplan-Meier method was used to estimate overall survival (OS) and progression free survival (PFS). Cox regression models were used to assess prognostic factors. Results: A total of 370 patients were included, 174 with de novo DLBCL, and 196 with TIL, 143 of the 196 had histologically confirmed transformation. Median age was 58 (22-73), and 59% of the patients were male. With a median follow-up of 82 months from HDT, the 5-year OS was 52% and the 5-year PFS was 44% (median PFS 3.2 years). For the DLBCL patients the 5-year OS was 43% and the 5-year PFS was 38%. For TIL patients the OS was 62% and the PFS 49% (figure 1). During the first 100 days, 29 patients (8%) were admitted to the intensive care unit (14 DLBCL), and only four of these patients were alive at six months. The non-relapse mortality (NRM) at day 100 was 6 % for both groups, after five years 25% for DLBCL and 15% for TIL. No significant difference in 5-year PFS was seen between sexes or age, but patients younger than 58 had better 5-year OS compared to patients aged 58 or above (p=0.047). There was no difference in relapse treatment (DHAP vs ICE). Smoking (ever vs. never) caused a significantly worse OS (p=0.034). All IPI-factors, except Ann Arbor stage, was of prognostic importance (PFS). Primary refractory disease was of poor prognostic importance (p=0.001), and in patients, for whom the time from last salvage treatment to reinfusion of stem cells was more than 2 months, had a worse outcome (p=0.006). Patients, with less than 20 days of hospital admission in the period from the date of relapse to start of HDT, had a significantly higher survival (OS and PFS) (p>0.001). In a multivariate analysis (PFS), LDH above upper normal reference, HR 1.4 (95% CI: 1.0;2.1), involvement of more than one extranodal site, HR 1.6 (1.1;2.3) primary refractory disease, HR 1.6 (1.1;2.3) and more than two earlier relapses, HR 1.9 (1.1;3.5) were all factors associated with adverse outcome. For OS, the multivariate analysis showed, that patients with TIL had a better outcome, HR 0.7 (0.5;0.9), compared to DLBCL. Age above 58, HR 1.5 (1.1;2.1), involvement of more than one extranodal site, HR 1.9 (1.4;2.8), and primary refractory disease, HR 1.6 (1.1;2.3) were factors associated with adverse outcome. Discussion: In this population based study we find a 5-year OS of 52% after HDT and a 5-year PFS of 44%. Patients with TIL have a significantly higher 5-year PS (49%) than patients with de novo DLBCL (38%) whereas NRM is identical for the two groups at day 100 (6%). However, NRM increases subsequently more for DLBCL than for TIL over time to 25% and 15 % respectively after five years. Furthermore we show that hospitalization days less than 20 and postponement of stem cell infusion beyond 2 month after harvest may be useful parameters that can identify patients that have better or worse outcome after HDT. This nationwide study cohort with the long follow-up period is applicable to a general population of patients, and this may explain the somewhat lower outcome compared to other published HDT cohorts. Figure 1. Progression Free Survival (PFS) curves for Diffuse Large B-Cell Lymphomas (DLBCL) and Transformed Indolent Lymphomas (TIL) after high dose therapy with autologous stem cell transplant Figure 1. Progression Free Survival (PFS) curves for Diffuse Large B-Cell Lymphomas (DLBCL) and Transformed Indolent Lymphomas (TIL) after high dose therapy with autologous stem cell transplant Disclosures Brown: Bayer: Consultancy; Roche: Consultancy, Speakers Bureau.

High-Dose Therapy Improves Progression-Free Survival and Survival in Relapsed Follicular Non-Hodgkin’s Lymphoma: Results From the Randomized European CUP Trial

2003 ◽  
Vol 21 (21) ◽  
pp. 3918-3927 ◽  
Author(s):  
Harry C. Schouten ◽  
Wendi Qian ◽  
Stein Kvaloy ◽  
Adolfo Porcellini ◽  
Hans Hagberg ◽  
...  
Keyword(s):  
Stem Cell ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy ◽  
Hazard Ratios ◽  
Non Hodgkin's Lymphoma

Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed by autologous stem-cell transplantation is more effective than standard treatment with regard to progression-free survival (PFS) and overall survival (OS) in patients with relapsed follicular non-Hodgkin’s lymphoma; and to assess the additional value of B-cell purging of the stem-cell graft with regards to PFS and OS. Patients and Methods: Patients received three cycles of chemotherapy. Responding patients with limited bone marrow infiltration were eligible for random assignment to three further cycles of chemotherapy (C), unpurged HDT (U), or purged HDT (P). Results: Between August 1993 and April 1997, 140 patients were registered from 36 centers internationally, and 89 were randomly assigned. Reasons for not randomizing included patient refusal, early progression, or death on induction therapy. With a 69-month median follow-up, the log-rank P value for PFS and OS were .0037 and .079, respectively. For PFS, the hazard ratios (95% CIs) for U versus C, P versus C, and P versus U were 0.33 (0.16 to 0.70), 0.38 (0.19 to 0.79), and 1.02 (0.51 to 2.05), respectively. The hazard ratio (95% CI) for C versus U + P was 0.30 (0.15 to 0.61). Hazard ratios (95% CIs) for OS were 0.43 (0.18 to 1.06), 0.43 (0.18 to 1.02), and 0.72 (0.32 to 1.63). For C versus U + P, the hazard ratio (95% CI) was 0.40 (0.18 to 0.89). Kaplan-Meier estimates (95% CIs) of 2-year PFS for C, U, and P were 26% (8% to 44%), 58% (37% to 79%), and 55% (34% to 75%), respectively. OS at 4 years for C, U, and P are 46% (25% to 67%), 71% (52% to 91%), and 77% (60% to 95%) respectively. Conclusion: HDT significantly improves PFS and OS. There is no clear evidence of benefit through purging.

scholarly journals High-dose therapy and autologous stem-cell transplantation can improve event-free survival for indolent lymphoma

Cancer ◽  
2007 ◽  
Vol 109 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Steéphane Vignot ◽  
Nicolas Mounier ◽  
Jeérôme Larghero ◽  
Pauline Brice ◽  
Laurent Quero ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
High Dose ◽  
Indolent Lymphoma ◽  
Event Free Survival ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy

scholarly journals High-dose therapy and autologous peripheral blood stem cell transplantation for patients with lymphoma

Blood ◽  
1989 ◽  
Vol 74 (4) ◽  
pp. 1260-1265 ◽  
Author(s):  
A Kessinger ◽  
JO Armitage ◽  
DM Smith ◽  
JD Landmark ◽  
PJ Bierman ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Event Free Survival ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy

Abstract Forty patients with refractory Hodgkin's disease (24 patients) or non- Hodgkin's lymphoma (16 patients) who were considered for high-dose therapy but not for autologous bone marrow transplantation (ABMT) due to BM metastases, previous pelvic irradiation, a history of marrow involvement by tumor or hypocellular marrow in conventional harvest sites received high-dose therapy and autologous peripheral blood (PB) hematopoietic stem cell transplantation. Disappearance of circulating neutrophils and development of RBC and platelet transfusion-dependence was followed, in the evaluable patients, by reappearance of 0.5 x 10(9)/L circulating granulocytes and sufficient platelets to obviate the need for platelet transfusions at a median of 25 days after transplantation. Twenty-three patients experienced a clinical complete remission (CR). The projected 2-year event-free survival was 24% for all 40 patients and 49% for the non-Hodgkin's lymphoma patients. The projected 18-month event-free survival for the Hodgkin's disease patients was 15%. PB stem cell transplantation provided an opportunity to administer high-dose salvage therapy to patients with refractory lymphoma who otherwise were not candidates for such therapy. For some of those patients, the high-dose therapy produced prolonged survival, free of tumor progression.

High-Dose [131I]Tositumomab (anti-CD20) Radioimmunotherapy and Autologous Hematopoietic Stem-Cell Transplantation for Adults ≥ 60 Years Old With Relapsed or Refractory B-Cell Lymphoma

2007 ◽  
Vol 25 (11) ◽  
pp. 1396-1402 ◽  
Author(s):  
Ajay K. Gopal ◽  
Joseph G. Rajendran ◽  
Ted A. Gooley ◽  
John M. Pagel ◽  
Darrell R. Fisher ◽  
...  
Keyword(s):  
Older Adults ◽  
Stem Cell ◽  
B Cell ◽  
Therapeutic Option ◽  
B Cell Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Hematopoietic Stem ◽  
Dose Therapy ◽  
Anti Cd20

Purpose The majority of patients with relapsed or refractory B-cell non-Hodgkin's lymphoma (NHL) are older than 60 years, yet they are often denied potentially curative high-dose therapy and autologous stem-cell transplantations (ASCT) because of the risk of excessive treatment-related morbidity and mortality. Myeloablative anti-CD20 radioimmunotherapy (RIT) can deliver curative radiation doses to tumor sites while limiting exposure to normal organs and may be particularly suited for older adults requiring high-dose therapy. Patients and Methods Patients older than 60 years with relapsed B-cell NHL (B-NHL) received infusions of tositumomab anti-CD20 antibody labeled with 185 to 370 Mbq (5 to 10 mCi) [131I]-tracer for dosimetry purposes followed 10 days later by individualized therapeutic infusions of [131I]tositumomab (median, 19.4 Gbq [525 mCi]; range, 12.1 to 42.7 Gbq [328 to 1,154 mCi]) to deliver 25 to 27 Gy to the critical normal organ receiving the highest radiation dose. ASCT was performed approximately 2 weeks after therapy. Results Twenty-four patients with a median age of 64 years (range, 60 to 76 years), who had received a median of four prior regimens (range, two to 14 regimens), were treated. Thirteen patients (54%) had chemotherapy-resistant disease. The estimated 3-year overall and progression-free survival rates were 59% and 51%, respectively, with a median follow-up of 2.9 years (range, 1 to 6 years). All patients experienced expected myeloablation with engraftment of platelets (≥ 20 K/μL) and neutrophils (≥ 500/μL), occurring at a median of 9 and 15 days after ASCT, respectively. There were no treatment-related deaths, and only two patients experienced grade 4 nonhematologic toxicity. Conclusion Myeloablative RIT and ASCT is a safe and effective therapeutic option for older adults with relapsed B-NHL.

Efficacy and Safety Of Treatments For Relapsed Or Refractory DLBCL: Results Of a Systematic Literature Review

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5104-5104 ◽  
Author(s):  
Ann Colosia ◽  
Peter C Trask ◽  
Robert Olivares ◽  
Shahnaz Khan ◽  
Adeline Abbe ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cell Transplant ◽  
Efficacy And Safety ◽  
Free Survival ◽  
Career Development Award

Abstract Background Diffuse large B-cell lymphoma (DLBCL) accounts for 30% to 40% of non-Hodgkin’s lymphoma (NHL) cases in Western countries. Although two-thirds of patients may be cured with combination chemotherapy, in the event of treatment failure and for those who are refractory to treatment, survival is usually measured in months. Several therapeutic modalities have been utilized for patients with relapsed or refractory disease, but among patients who are not eligible for high-dose chemotherapy with stem cell transplant, a comprehensive assessment of efficacy and safety is lacking. This systematic literature review (SLR) was designed to exhaustively collect and review information on the clinical efficacy and safety of the different interventions used in the treatment of refractory or relapsed DLBCL, and if possible to perform a meta-analysis. Methods Electronic databases (PubMed, Cochrane Library, Embase) were searched for relevant studies published from 1997 to August 2, 2012. In addition, conference abstracts, bibliographic reference lists of included articles and recent reviews, and the Clinicaltrials.gov database were searched for phase 2, 3, or 4 studies displaying results, potentially unpublished in peer-reviewed journals. Main efficacy outcomes included objective response rate (ORR), complete response, partial response, duration of response, progression-free survival (PFS), and overall survival (OS). Safety endpoints focused on grade 3/4 toxicities and treatment discontinuation due to toxicity. Studies had to report on relapsed or refractory DLBCL after at least one standard treatment and patients who were not eligible to receive high-dose chemotherapy or stem cell transplant (autologous or allogeneic). Mixed type NHL studies were required to report DLBCL outcomes separately for inclusion. Results A total of 3,308 publications were identified in the first pass of a broad SLR on NHL; of these, 57 provided relevant data for DLBCL representing 54 unique studies. Of the 54 studies, there was 1 phase 3 study, 33 phase 2 studies, and 4 phase 1/2 studies (15 studies did not report the study phase and 1 was an observational study). Six studies were comparative (3 randomized trials; 3 nonrandomized trials) with two treatment arms; 48 studies were single arm. Of the 48 regimens evaluated, few regimens were represented more than once. Overall survival and PFS were often not reported or not reported separately for the patients with DLBCL in studies that enrolled patients with any of the multiple lymphoma histologies. Refractory and relapsed criteria were often not defined, and definitions were heterogeneous when available. The ORR from the few comparative studies ranged from 27% to 100%, with most estimates between 40% and 70%. PFS with low and high doses of obintuzumab was 2 months and 3 months, respectively in one study, and OS was 4 months with MEP and 7 months with C-MEP in another study. There was a common regimen in two of the randomized controlled trials, but the patient populations in these studies differed too greatly to allow a valid meta-analysis to be performed. In the single-arm studies, ORR ranged from 11% to 100%, with the estimates evenly distributed across that range. Progression-free survival was approximately 1 to 10 months. Reported median OS ranged from 1 to 13 months. Main safety concerns included thrombocytopenia, leukopenia, and neutropenia. Conclusions There is a high unmet need for effective therapies for patients with relapsed or refractory DLBCL who are ineligible for stem cell transplant. Although numerous regimens have been evaluated in single-arm trials and a handful in comparative studies, there is no clearly superior regimen for patients with relapsed or refractory DLBCL, especially in third- and later lines of therapy. FA is supported by a Clinical Career Development Award from the Lymphoma Research Foundation Disclosures: Colosia: RTI Health Solutions: Employment. Trask: Sanofi: Employment. Olivares: Sanofi: Employment. Khan: RTI Health Solutions: Employment. Abbe: Sanofi: Employment. Police: RTI Health Solutions: Employment. Njue: RTI Health Solutions: Employment. Wang: RTI Health Solutions: Employment. Sherrill: RTI Health Solutions: Employment. Ruiz-Soto: Sanofi: Employment. Kaye: RTI Health Solutions: Employment. Awan: Lymphoma Research Foundation (Career Development Award): Research Funding.

Augmented Preparative Regimens Using Total Body Irradiation or BCNU Prior to Autologous Stem Cell Transplant (AuSCT) Are Well-Tolerated and Yield Substantial Rates of Progression-Free Survival in Patients with Poor Risk Hodgkin Lymphoma (HL) or Diffuse Large B-Cell Lymphoma (DLBCL).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5499-5499
Author(s):  
David S. Ritchie ◽  
John F. Seymour ◽  
Sarah Thompson ◽  
Michael McManus ◽  
Miles Prince
Keyword(s):  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Salvage Chemotherapy ◽  
Cell Transplant ◽  
Indolent Lymphoma ◽  
Free Survival ◽  
Poor Risk ◽  
Induction Failure ◽  
Consolidative Radiotherapy

Abstract Introduction: AuSCT using conditioning such as BEAM, for relapsed DLBCL and HL results in progression-free survival (PFS) of 60% of cases in second complete remission (CR). Those who do not achieve a second CR or who have primary refractory disease have significantly reduced benefit from BEAM/AuSCT. Consequently, we have been offering dose intensified conditioning prior to AuSCT with the Stanford regimen using Etoposide 60mg/kg day-4, Cyclophosphamide 100mg/kg day-2 and either BCNU 15mg/kg day-6 or fractionated TBI 12Gy days-8 to -5 to patients with poor risk haematologic malignancy. Methods: We assessed the outcome of AuSCT in 46 patients with poor risk haematologic disease; DLBCL (n=16), HL (n=16), multiply relapsed indolent lymphoma (n=8) and aggressive “other” lymphomas (n=6) who received conditioning with either the BNCU (n=31) or TBI (n=15) protocols. Of the 32 patients with HL or DLBCL, 28 had previously failed to achieve a CR to salvage chemotherapy; PR (21/32) or induction failure/early progression (7/32). Results: There were no transplant-related deaths among the 32 HL or DLBCL patients. One case of fatal radiation pneumonitis occurred following consolidative radiotherapy 6 months post AuSCT. The PFS for the combined HL/DLBCL cohort was 65±9% at 12, and 61±9% at 24 months. The 24 month PFS by BCNU or TBI regimen was 63% and 57% respectively (p=0.56). The 24 month PFS for HL or DLBCL treated with either regimen was 54±13% and 68±12% respectively (P=0.34) Additional groups were too heterogeneous to statistically assess. 1 of 6 patients with aggressive “other” lymphoma maintained a durable remission (39 months) and 4/8 patients with indolent lymphoma have ongoing CR at 9 – 59 months follow up. Conclusions: Stanford TBI or BCNU conditioning prior to AuSCT are well-tolerated and result in substantial rates of PFS in patients with poor risk HL or DLBCL.

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