Central Nervous System (CNS) Relapse In a Population of 143 Patients (Pts) with Mantle Cell Lymphoma (MCL) From Two Centers

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2660-2660
Author(s):  
Annarita Conconi ◽  
Silvia Franceschetti ◽  
Chiara Lobetti-Bodoni ◽  
Anastasios Stathis ◽  
Riccardo Bruna ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Intrathecal Chemotherapy ◽  
High Dose ◽  
Cns Disease ◽  
Cns Relapse

Abstract Abstract 2660 Inconsistent information concerning the pattern of CNS relapse have been reported in MCL pts. We retrospectively analyzed the clinical variables at diagnosis and outcome, with special reference to CNS relapse, in a population of consecutive pts with confirmed diagnosis of MCL from two hematology centers. Among 2426 non Hodgkin's lymphoma pts treated from 1979 to 2011, 142 cases (44 female, 98 male) of MCL were selected. Median age at diagnosis was 68 years (17–94 years); 116 pts (82%) had stage III-IV, 89 (67% of the 132 cases in whom the data was available) had intermediate-high/high International Prognostic Index (IPI) risk. Extranodal disease was reported in 127 pts (89%), serum LDH was elevated in 45 pts (40% of 113 tested pts). Information concerning first line treatment was available in 139 pts. Fourteen pts (10%) did not receive active treatment at diagnosis, in 7 (5%) of these, systemic treatment followed the initial expectant strategy. Four pts (3%) only received radiotherapy and/or surgery. One hundred twenty two pts (88%) were treated with chemotherapy, 46 pts (33%) had rituximab, alone (6 pts, 4%) or in combination with chemotherapy. Eighteen pts (13%) received chemotherapy regimens including drugs crossing the blood-brain barrier or prophylactic intrathecal chemotherapy, 10 pts (7%) had autologous stem cell transplantation. After median follow-up of 8 years, CNS relapse was observed in 11 cases (7.7%; 95%CI:4–13%). CNS disease occurred at a median of 13.8 months (range:3.7–95 months) from diagnosis. Cumulative risk of CNS relapse raises until 10 years, being 7.2% (95%CI:4–14%) at 3 years, 10.6% (95%CI:6–19%) at 5 years and 13.6% (95%CI:7–25%) at 10 years. Elevated serum LDH at diagnosis was significantly associated with higher risk of CNS relapse at univariate analysis (P=0.006). Actuarial risk of CNS relapse was significantly shorter in pts with higher risk according to IPI (P=0.018). Median survival after CNS relapse was 6.3 months (range: 1.5–77 months). CNS relapse had a dismal impact on survival (P=0.04). No specific treatment approach at diagnosis, including autologous stem cell transplantation, intrathecal chemotherapy, high dose cytarabine or rituximab, alone or in combination with chemotherapy, significantly reduced the risk of CNS relapse. CNS relapse is one of the most challenging events in the management of MCL. Our data confirmed the adverse clinical outcome of MCL after CNS relapse. Better definition of clinico-pathological profile at diagnosis suggesting higher risk of CNS relapse could select pts candidate to prophylactic approach addressed to prevent CNS disease. Disclosures: No relevant conflicts of interest to declare.

Outcomes after autologous stem cell transplantation in relapsed or refractory Hodgkin disease: The Duke experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8100-8100
Author(s):  
D. W. Kim ◽  
D. Misra ◽  
R. W. Clough ◽  
G. D. Long ◽  
R. G. Prosnitz
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Medical Center ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Retrospective Chart Review ◽  
High Dose

8100 Background: High dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) offers patients with relapsed or refractory Hodgkin's disease (HD) the possibility of durable long term remission. We examined the characteristics and outcomes of patients treated at Duke University Medical Center between May 1997 and May 2006. Methods: We performed a retrospective chart review on all patients with relapsed or refractory HD who received HDT followed by ASCT at our institution. Various prognostic factors were also analyzed for their impact on overall survival (OS) and disease free survival (DFS). Results: Sixty-one patients received HDT followed by ASCT for relapsed or refractory HD. Median age was 33 years (range: 16 years to 64 years). The patient population was comprised primarily of males (64%), Caucasians (80%), and patients with nodular sclerosing histology (77%). Fifty-six percent of patients had primary refractory HD. At the time of relapse, 44% of patients had stage I-II disease, and 21% had B symptoms. For patients with relapsed disease, the median time from initial diagnosis to relapse was 17 months. Most patients (64%) received cyclophosphamide, etoposide, and BCNU chemotherapy as HDT. Thirty-one percent of patients received consolidative radiotherapy after HDT. Twenty-eight percent of patients had chemotherapy- responsive disease prior to undergoing HDT. Following ASCT, 46/61 (75%) of patients achieved a complete response. Transplant-related deaths occurred in 2/61 (3%) patients. With a median follow-up of 2.5 years (range: 3 months to 8.8 years), the actuarial 5-year OS and DFS were 79% and 50%, respectively. The most common post-therapy complication was pneumonitis, which occurred in 62% of patients. Three (5%) patients developed second malignancies. On univariate analysis, gender, stage at diagnosis, stage at relapse, presence of B symptoms at relapse, and the interval to first relapse did not significantly affect OS or DFS. Conclusions: Our results confirm that HDT followed by ASCT offers an excellent chance for long-term DFS and OS in patients with relapsed or refractory HD, with a low risk of treatment-related mortality. No significant financial relationships to disclose.

scholarly journals MYC + diffuse large B-cell lymphoma is not salvaged by classical R-ICE or R-DHAP followed by BEAM plus autologous stem cell transplantation

Blood ◽  
2012 ◽  
Vol 119 (20) ◽  
pp. 4619-4624 ◽  
Author(s):  
Wendy Cuccuini ◽  
Josette Briere ◽  
Nicolas Mounier ◽  
Hans-Ullrich Voelker ◽  
Andreas Rosenwald ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Large B Cell

Abstract Approximately 5-10% of diffuse large B-cell lymphomas (DLBCL) harbor a 8q24/MYC rearrangement (MYC+). We determined the prognostic significance of MYC rearrangement in patients with relapsed/refractory DLBCL prospectively treated by R-ICE or R-DHAP followed by high-dose therapy and autologous stem cell transplantation. Twenty-eight (17%) of the 161 patients analyzed presented a MYC+ rearrangement, targeted as either simple hit (25%) or complex hits (n=75%) including MYC/BCL2, MYC/BCL6, and MYC/BCL2/BCL6. Results were statistically highly concordant in matched primary and relapsed biopsies (n = 45). Compared to the MYC− DLBCL patients, the MYC+ DLBCL patients presented with a more elevated lactico-deshydrogenase level (P = .0006) and a more advanced age adjusted international prognostic index (P = .0039). The 4-year PFS and OS were significantly lower in the MYC+ DLBCL patients than those in the MYC− DLBCL patients, with rates of 18% vs 42% (P = .0322), and of 29% vs 62% (P = .0113), respectively. Type of treatment, R-DHAP or R-ICE, had no impact on survivals, with 4-year PFS rates of 17% vs 19% and 4-year OS rates of 26% vs 31%. In conclusion, MYC rearrangement is an early event in DLBCL. MYC+ DLBCL patients have a significant inferior prognosis than MYC− DLBCL patients. Their outcome was not influenced by the proposed salvage therapy.

CNS-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT) for CNS relapse of aggressive lymphomas: Final analysis of a phase II study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8031-8031 ◽  
Author(s):  
Agnieszka Korfel ◽  
Gerald Illerhaus ◽  
Mathias Haenel ◽  
Robert Moehle ◽  
Roland Schroers ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Phase Ii Study ◽  
Final Analysis ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Liposomal Cytarabine ◽  
Cns Relapse

8031 Background: The outcome of patients with CNS relapse of aggressive lymphoma (secondary CNS lymphoma, SCNSL) is poor with no standard therapy established thus far. Here we present the final analysis of a prospective multicenter phase II study using an intensive induction regimen followed by high-dose chemotherapy and autologous stem-cell transplantation. Methods: Adult immunocompetent patients ≤65 years with SCNSL were eligible. Induction chemotherapy consisted of two cycles MTX/IFO (methotrexate 4g/m2 iv. d1, ifosfamide 2g/m2 iv. d3-5 and i.th. liposomal cytarabine 50mg d6) and one cycle AraC/TT (cytarabine 3g/m2 d1-2, thiotepa 40mg/m2 iv. d2 and i.th. liposomal cytarabine 50mg d3). Then, patients without progression received high-dose chemotherapy with carmustine 400mg/m2 iv. d -5, thiotepa 2x5mg/kg iv. d -4 to -3 and etoposide 150mg/m2 iv. d -5 to -3 followed by ASCT d0. Results: Thirty eligible patients (median age 58 years) were enrolled. Three patients had T-cell and 27 aggressive B-cell lymphoma. Pre-treatment was CHOP-like in 29 patients, including rituximab in 26. CNS relapse occurred after a median of 8.5 (3-80) months and was intracerebral in 23 and meningeal in13 patients (combined in 7); 6 had concomitant systemic lymphoma. After induction therapy CNS response was found in 22 (73%) patients (8xCR, 14xPR), 3 patients had SD, 4 patients PD and 1 patient no response evaluation. HD-ASCT was performed in 24 patients; resulting in 15 CR (63%), 2 PR (8%) and 7 PD (29%). Myelotoxicity was the most frequent WHO grade 3-4 adverse event with infections in 8/30 pts on MTX/IFO (27%), 5/23 (22%) on AraC/TT and 11/20(55%) on HD-ASCT. One patient died due to septic diverticulitis and one developed persisting fecal incontinence. The median follow up was 21 months. The median PFS was 12.1 months (95% CI 6.4-17.7) in all patients and 30.4 (95%CI 2.5-58.3) months after HD-ASCT, the median overall survival was 27.4 months and not reached, respectively. Conclusions: This first prospective study on SCNSL demonstrates that lasting remissions can be achieved with CNS-directed HD-ASCT in a large proportion of patients and probably cure in some.

Impact of Three Courses of Intensified CHOP Prior to High-Dose Sequential Therapy Followed by Autologous Stem-Cell Transplantation As First-Line Treatment in Poor-Risk, Aggressive Non-Hodgkin's Lymphoma: Comparative Analysis of Dutch-Belgian Hemato-Oncology Cooperative Group Studies 27 and 40

2005 ◽  
Vol 23 (16) ◽  
pp. 3793-3801 ◽  
Author(s):  
Gustaaf W. van Imhoff ◽  
Bronno van der Holt ◽  
Marius A. MacKenzie ◽  
Mars B. van′t Veer ◽  
Pierre W. Wijermans ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Sequential Therapy ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Cooperative Group ◽  
Free Survival ◽  
Poor Risk

Purpose Timing, appropriate amount, and composition of treatment before high-dose therapy and autologous stem-cell transplantation (ASCT) in patients with poor-risk, aggressive non-Hodgkin's lymphoma (NHL) are still unknown. We conducted two consecutive multicenter phase II trials with up-front, high-dose, sequential chemotherapy and ASCT in poor-risk, aggressive NHL. Both trials had identical inclusion criteria and only differed in amount and duration of induction treatment before ASCT. Patients and Methods Between 1994 and 2001, 147 newly diagnosed, poor-risk, aggressive NHL patients, age ≤ 65 years with stage III to IV and lactate dehydrogenase (LDH) more than 1.5× upper limit of normal (ULN), entered the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON) -27 and HOVON-40 trials. Treatment in HOVON-27 consisted of two up-front, high-dose induction courses followed by carmustine, etoposide, cytarabine, and melphalan plus ASCT in responding patients. In HOVON-40, the same treatment was preceded by three intensified courses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Results Patient characteristics in both trials were comparable: 80% had diffuse large B-cell lymphoma, 77% had stage IV disease, and median LDH levels were 3.1× ULN. Complete remission (CR) in both trials was 45% to 51%. Before ASCT, CR was 14% in HOVON-27 versus 28% in HOVON-40 (P = .03). Treatment failure was similar (27%). Four-year survival estimates in HOVON-27 compared with HOVON-40 were overall survival, 21% v 50% (P = .007); event-free survival, 15% v 49% (P = .0001); and disease-free survival, 34% v 74% (P = .008). This different outcome favoring HOVON-40 remained highly significant when correcting for competing risk factors in multivariate analysis. Conclusion In patients with poor-risk, aggressive NHL, addition of intensified CHOP before up-front, high-dose, sequential therapy and ASCT significantly improved the duration of response and survival.

Sign in / Sign up

Export Citation Format

Share Document