Dose-intensive cyclophosphamide, etoposide, cisplatin reinduction for relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6548-6548
Author(s):  
Jan-Willem Henning ◽  
Qiuli Duan ◽  
Nizar J. Bahlis ◽  
Andrew Daly ◽  
Peter Duggan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Cell Mobilization ◽  
N 93

6548 Background: Approximately 2/3 r/r-aNHL patients (pts) respond to salvage R-ICE or R-DHAP, 1/2 proceed to autologous stem cell transplantation (ASCT), and 1/3 achieve 3 year (yr) progression-free survival (PFS); however, PFS is only 20% if prior Rituximab, time to progression (TTP)<1yr, or age-adjusted International Prognostic Index (aaIPI)=2-3 [JCO 2010;28: 4184-90]. Since 1995, we re-induced poor prognosis r/r-aNHL with dose-intensive Cyclophosphamide 5.25g/m2, Etoposide 1.05g/m2 and Cisplatin 105mg/m2 (DICEP), G-CSF days (d) 14-19, and apheresis d19,20, or 21. Rituximab was added d0,7 after 2006. Methods: We retrospectively analyzed 113 consecutive transplant eligible r/r-aNHL pts [diffuse large B-cell=95, transformed=9, peripheral T-cell=6, other=3] who received one cycle of DICEP (n=93) or R-DICEP (n=20) from 1995-2009. Patient characteristics included: median age=49yr (22-69); primary refractory=68; TTP<1yr=85; elevated LDH=60; ECOG 2-4=42; aaIPI 2-3=59; bulk>10cm=26. Results: Of 113 pts, 77% responded to DICEP and 90% (102) proceeded to ASCT. The median CD34+ cells collected was 19x106/kg (0.3-142). Early treatment-related mortality (TRM) occurred in 3 pts (2.7%), and 4 others developed late second cancers (MDS/AML=2). With 94 months median follow-up (26-194), 5 and 10yr OS rates for all 113pts are 48% and 41%, and PFS rates are 42% and 37%, respectively. 5 year PFS rates for ASCT vs no-ASCT are 46% vs 9%, for relapse aaIPI=0-1 vs aaIPI=2-3 are 53.3% vs 32.1% (p=0.01), and for TTP>1yr vs <1yr are 63.9% vs 35.2% (p=0.009). Other predictors of inferior PFS in univariate analysis were elevated LDH, ECOG 2-4, no response to DICEP; however, PFS for 27 pts who failed prior Rituximab-chemotherapy (56%) was similar to other 86 pts (38%) (logrank p=0.09). Predictors of PFS and OS in multivariate analysis include: TTP<1yr, elevated LDH, bulk, no response to DICEP. Conclusions: (R)DICEP is an effective re-induction regimen for r/r-aNHL, leading to excellent stem cell mobilization and a high chance of proceeding to ASCT. Long-term PFS and OS rates compare favourably to reports of other re-induction regimens, and a prospective multicentre trial is warranted.

Treatment of Indolent B-Cell Nonfollicular Lymphomas: Final Results of the LL01 Randomized Trial of the Gruppo Italiano per lo Studio dei Linfomi

2003 ◽  
Vol 21 (8) ◽  
pp. 1459-1465 ◽  
Author(s):  
Luca Baldini ◽  
Maura Brugiatelli ◽  
Stefano Luminari ◽  
Marco Lombardo ◽  
Francesco Merli ◽  
...  
Keyword(s):  
B Cell ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
High Dose ◽  
Free Survival ◽  
Significant Difference

Purpose: To evaluate the effect of epirubicin on therapeutic response and survival in patients with indolent nonfollicular B-cell lymphomas (INFL) treated with pulsed high-dose chlorambucil. Patients and Methods: A total of 170 untreated patients with advanced/active INFL were randomly assigned to receive either eight cycles of high-dose chlorambucil (15 mg/m2/d) plus prednisone (100 mg/d) for 5 days (HD-CHL-P; arm A) or eight cycles of HD-CHL-P plus epirubicin 60 mg/m2 intravenous on day 1 (arm B). The responding patients were randomly assigned to either maintenance therapy with interferon alfa (IFNα-2a; 3 MU, three times weekly) for 12 months or observation. Results: There were 160 assessable patients (82 males, 78 females; median age, 63 years; range, 33 to 77 years); 77 patients were assigned to arm A, and 83 were assigned to arm B. Induction therapy led to 47 complete responses (CRs; 29.4%) and 68 partial responses (PRs; 42.5%), with no significant difference between the two arms (60 CR + PR in arm A [77.9%] and 55 CR + PR in arm B [66.3%]; P = .07). After a median follow-up of 38 months (range, 2 to 103 months), there was no between-group difference in overall survival (OS; P = .45), failure-free survival (P = .07), or progression-free survival (PFS; P = .5). Eighty-eight patients were randomly assigned to either IFNα-2a (n = 43) or observation (n = 45), without any difference in 3-year PFS (44% and 42%, respectively). Univariate analysis showed that OS was influenced by age, anemia, serum lactate dehydrogenase levels, and International Prognostic Index distribution; multivariate analysis identified age and anemia as having influence on OS. Conclusion: HD-CHL-P treatment outcome in INFL patients was good (50% 3-year PFS, minimal toxicity, and low costs); epirubicin did not add any advantage. One-year IFNα maintenance treatment did not prolong response duration.

Revised International Prognostic Index (R-IPI) Is a Better Predictor of Outcome Than the Standard IPI for Patients with Diffuse Large B-Cell Lymphoma (DLBCL) Treated with Rituximab and CHOP (R-CHOP).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 492-492 ◽  
Author(s):  
Laurie H. Sehn ◽  
Mukesh Chhanabhai ◽  
Catherine Fitzgerald ◽  
Karamjit Gill ◽  
Paul Hoskins ◽  
...  
Keyword(s):  
Overall Survival ◽  
International Prognostic Index ◽  
Young Patients ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Patient Characteristics ◽  
Research Database ◽  
Clinical Tool ◽  
Field Radiation

Abstract Background: The IPI, which was developed prior to the availability of rituximab, remains the primary clinical tool used to predict outcome for patients with DLBCL. Since clinical trials investigating the use of rituximab and chemotherapy in this patient population have been confined to either elderly or young patients exclusively, the utility of the IPI in the era of immuno-chemotherapy remains unknown. Methods: We performed a retrospective analysis to assess the predictive value of the IPI in an unselected population of patients with DLBCL treated with R-CHOP. Patients were identified using the Lymphoid Cancer Research Database of the British Columbia (BC) Cancer Agency. We included all patients ≥16 years of age who were newly diagnosed with DLBCL prior to Jan 15, 2005, and were treated in BC with an R-CHOP protocol. Patients were excluded if they were HIV positive, had evidence of an active second malignancy or an underlying indolent lymphoma. Results: 365 patients were identified. Patient characteristics were as follows: median age 61 y (16–90); male, 61%; advanced stage III/IV, 59%; elevated LDH, 54%; PS≥2, 40%; &gt;1 extranodal site, 35%. Central pathology review was performed on 95% of patients; 324 DLBCL, 36 PMBCL, 5 other. All patients received R-CHOP; 9% were treated with R-CHOP x 3 and involved field radiation therapy for limited stage disease, remaining patients received 6–8 cycles of R-CHOP. Median follow-up for living patients is 22 months. Overall, the IPI remains predictive for both progression-free survival (p&lt;0.0001) and overall survival (p&lt;0.0001). However, the IPI no longer permits separation between the two low risk subgroups (low v low-intermediate) or between the two high risk subgroups (high-intermediate v high). (see Table) An alternate grouping of the IPI is proposed (R-IPI) that identifies three distinct prognostic groups. (see Table and Figure) Conclusions: The IPI remains predictive in the era of immuno-chemotherapy, but the R-IPI provides a simplified and more accurate prediction of outcome. The IPI factors can no longer be used to identify a group with less than a 50% chance of survival. Overall Survival According to Revised IPI (R-IPI) Overall Survival According to Revised IPI (R-IPI)

Clinical Impact and Resource Utilization After Stem Cell Mobilization Failure in Patients with Multiple Myeloma and Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2142-2142
Author(s):  
Morie A Gertz ◽  
Robert Wolf ◽  
Ivana N. Micallef ◽  
Dennis A. Gastineau
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Growth Factors ◽  
Hodgkin Lymphoma ◽  
Resource Utilization ◽  
Stem Cell Mobilization ◽  
Hodgkin Disease ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Abstract 2142 Poster Board II-119 High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal stem cell mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of stem cell mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing mobilization during the study period, stem cell collection (defined by the number of CD34+ cells/kg) was “ optimal” (≥5×106) in 53%, “low” (≥2 to 5×106) in 25%,“ poor” (<2×106) in 10%, and “failed” (<10 CD34+ cells/mL) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. Other costs often omitted include the need for hospitalization, which was seen in 5% to 11% of the patients in our study. Parenteral antibiotics were needed when fever developed in 7% of patients with Hodgkin disease, 4% with non-Hodgkin lymphoma, and 24% with multiple myeloma who underwent mobilization using a chemotherapy pulse. When stem cell mobilization was not immediately optimal, subsequent attempts to mobilize failed completely in 3 of 42 patients (7%) with Hodgkin disease (3% of the original Hodgkin disease cohort), 56 of 157 (36%) with multiple myeloma (6% of the original myeloma cohort), and 50 of 328 (15%) with non-Hodgkin lymphoma (7% of the original non-Hodgkin lymphoma cohort). These usually unappreciated costs of stem cell mobilization failure highlight the need for more effective mobilization strategies. Disclosures: Gertz: genzyme: Research Funding.

Autologous stem cell transplantation for HIV-associated lymphoma

Blood ◽  
2001 ◽  
Vol 98 (13) ◽  
pp. 3857-3859 ◽  
Author(s):  
Amrita Krishnan ◽  
Arturo Molina ◽  
John Zaia ◽  
Auayporn Nademanee ◽  
Neil Kogut ◽  
...  
Keyword(s):  
Stem Cell ◽  
Antiretroviral Therapy ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Viral Loads ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Cell Mobilization ◽  
Intensive Approach

Abstract Is peripheral stem cell mobilization followed by autologous stem cell transplantation (ASCT) feasible in patients with human immunodeficiency virus (HIV)– associated lymphoma (HIV-L)? Studies have demonstrated that, in the HIV- negative (HIV−) setting, ASCT may improve lymphoma-free survival in high-risk non-Hodgkin lymphoma (NHL) or relapsed Hodgkin disease (HD) and NHL. Given the poor prognosis of HIV-L with conventional chemotherapy, this dose-intensive approach was explored. Nine patients with HIV-HD or NHL mobilized a median of 10.6 × 106 CD34+ cells/kg and engrafted after ASCT. CD4 counts recovered to pretransplantation levels and HIV viral loads were controlled in patients compliant with antiretroviral therapy. Seven of 9 patients remain in remission from their lymphoma at a median of 19 months after transplantation. Thus, patients with HIV-L on antiretroviral therapy can engraft following ASCT. Prolonged lymphoma remissions, without significant compromise of immune function, can be seen, suggesting that ASCT can be used in selected patients with HIV-L.

Mid-Treatment 18-FDG-Positron Emission Tomography/Computed Tomography (PET) Does Not Impact the Outcome in Patients with Aggressive Non Hodgkin Lymphoma (NHL)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5295-5295
Author(s):  
Patrizia Pregno ◽  
Annalisa Chiappella ◽  
Marilena Bellò ◽  
Giulia Benevolo ◽  
Carola Boccomini ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Response Assessment ◽  
Complete Response ◽  
Course Evaluation ◽  
High Dose ◽  
Early Evaluation ◽  
End Of Treatment

Abstract Introduction and aim of the study. PET is used in staging and restaging of aggressive NHL patients at diagnosis and at the end of treatment. Early evaluation of PET after few courses of chemotherapy was reported to predict final response, progression-free survival (PFS) and overall survival (OS) in Hodgkin’s lymphoma patients, whereas contradictory data were shown in aggressive lymphomas. The aim of our study was to evaluate mid-treatment PET (PET-2) results in aggressive NHL. Patients and methods. From April 2004 to December 2007, 42 consecutive aggressive NHL patients were referred to our Hematology Department and enrolled into the study. Clinical characteristics were as follows: 29 males and 13 females; median age of 53 years (25–73); 34 diffuse large B cell, 5 mantle cell, 2 anaplastic and 1 follicular grade III NHL; 37 stage III–IV; according to International Prognostic Index (IPI) 1 patient was at low-intermediate risk, 21 at intermediate-high and 20 at high risk. Treatment plans were: Rituximab-CHOP-like chemotherapy (R-CHOP) for 6–8 courses in 18 patients and R-CHOP for 4 courses followed by high-dose chemotherapy with autologous stem cell transplantation (HDC+ASCT) in 24 patients respectively. All pts were evaluated according to standard imaging procedures completed by PET at diagnosis and at the end of the treatment. During treatment, PET-2 scan was performed after 2 or 4 courses of R-CHOP in 24 and 18 patients respectively. Results. Complete response at the end of treatment was achieved in 33 patients and partial remission in 1; in 8 patients progression disease was detected. With a median follow-up of 22 months, 2-yr PFS and 2-yr OS rates were: 72% and 80% respectively. PET-2 was negative in 30 patients and positive in 12. Two-year PFS and 2-yr OS rates were not different between PET-2 negative and PET-2 positive patients: 71% vs 75% (p=.98) and 82% vs 74% (p=.29) respectively. Final PET scan was negative in 33 patients and positive in 9. The final PET assessment was highly predictive for 2-yr PFS: PET negative 86% vs PET positive 22% (p=.000). Also the 2-yr OS was influenced by final PET: 96% vs 26% in PET negative and PET positive patients respectively (p=.000). In univariate analysis the only parameter that influenced the outcome was the final PET; conversely, IPI, sex, histology, time of PET-2 evaluation, plan of therapy had not a statistically significative impact. Conclusions. The PET is an important imagine technique for staging and end-treatment evaluation in lymphoma disease, because it can better define CR patients. In contrast to Hodgkin disease, our data suggest that the on-course evaluation of response by PET has not predictive value of response assessment: patients, even if positive at PET-2 analysis, can achieve a continuous CR at the end of therapy. More large studies are need to determine the real impact of on-course PET as response assessment in aggressive NHL patients.

Autologous stem cell transplantation for HIV-associated lymphoma

Blood ◽  
2001 ◽  
Vol 98 (13) ◽  
pp. 3857-3859 ◽  
Author(s):  
Amrita Krishnan ◽  
Arturo Molina ◽  
John Zaia ◽  
Auayporn Nademanee ◽  
Neil Kogut ◽  
...  
Keyword(s):  
Stem Cell ◽  
Antiretroviral Therapy ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Viral Loads ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Cell Mobilization ◽  
Intensive Approach

Is peripheral stem cell mobilization followed by autologous stem cell transplantation (ASCT) feasible in patients with human immunodeficiency virus (HIV)– associated lymphoma (HIV-L)? Studies have demonstrated that, in the HIV- negative (HIV−) setting, ASCT may improve lymphoma-free survival in high-risk non-Hodgkin lymphoma (NHL) or relapsed Hodgkin disease (HD) and NHL. Given the poor prognosis of HIV-L with conventional chemotherapy, this dose-intensive approach was explored. Nine patients with HIV-HD or NHL mobilized a median of 10.6 × 106 CD34+ cells/kg and engrafted after ASCT. CD4 counts recovered to pretransplantation levels and HIV viral loads were controlled in patients compliant with antiretroviral therapy. Seven of 9 patients remain in remission from their lymphoma at a median of 19 months after transplantation. Thus, patients with HIV-L on antiretroviral therapy can engraft following ASCT. Prolonged lymphoma remissions, without significant compromise of immune function, can be seen, suggesting that ASCT can be used in selected patients with HIV-L.

Combination of Rituximab, Bendamustine, and Cytarabine for Patients With Mantle-Cell Non-Hodgkin Lymphoma Ineligible for Intensive Regimens or Autologous Transplantation

2013 ◽  
Vol 31 (11) ◽  
pp. 1442-1449 ◽  
Author(s):  
Carlo Visco ◽  
Silvia Finotto ◽  
Renato Zambello ◽  
Rossella Paolini ◽  
Andrea Menin ◽  
...  
Keyword(s):  
International Prognostic Index ◽  
Autologous Transplantation ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Response Duration ◽  
Complete Response ◽  
Maximum Tolerated Dose ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
Mantle Cell

Purpose The combination of bendamustine (B) and rituximab (R) is efficacious, with favorable toxicity in mantle-cell lymphoma (MCL). In this phase II study, we combined cytarabine with R and B (R-BAC) in patients with MCL age ≥ 65 years who were previously untreated or relapsed or refractory (R/R) after one prior immunochemotherapy treatment. Patients and Methods In stage one, we established the maximum-tolerated dose (MTD) of cytarabine in R-BAC. In stage two, patients received R (375 mg/m2 intravenously [IV] on day 1), B (70 mg/m2 IV on days 2 and 3), and cytarabine (MTD IV on days 2 to 4) every 28 days for four to six cycles. The primary end point (overall response rate [ORR]) was evaluated by positron emission tomography. Secondary end points included safety, progression-free survival (PFS), response duration, and overall survival. Results Forty patients (median age, 70 years; 20 previously untreated patients) were enrolled; 93% had Ann Arbor stage III/IV disease; 49% had high Mantle Cell International Prognostic Index scores, with 15% blastoid histology. All R/R patients (35% refractory) had previously received R-containing regimens. The cytarabine MTD used in stage two was 800 mg/m2, and R-BAC was well tolerated, with an 85% treatment completion rate. The major toxicity was transient grades 3 to 4 thrombocytopenia (87% of patients); febrile neutropenia occurred in 12%. The ORR was 100% (95% complete response [CR]) for previously untreated and 80% (70% CR) for R/R patients. The 2-year PFS rate (± standard deviation) was 95% ± 5% for untreated and 70% ± 10% for R/R patients. Conclusion R-BAC is well tolerated and active against MCL.

scholarly journals Allogeneic Stem Cell Transplantation from Unmanipulated Haploidentical Donors Versus Unrelated Cord Blood in Patients with T-Cell Non-Hodgkin Lymphoma : A Retrospective Study from the Societe Francophone De Greffe De Moelle Et De Therapie Cellulaire (SFGMC-TC)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4596-4596
Author(s):  
Jérôme Cornillon ◽  
Elisabeth Daguenet ◽  
Didier Blaise ◽  
Stephanie Nguyen ◽  
Gerard Socie ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Research Funding ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Non Hodgkin Lymphoma

Introduction. Allogeneic stem cell transplantation (SCT) can be curative for those with high-risk or recurrent hematologic cancers including T-cell non-Hodgkin's lymphoma (TCL). For patients lacking an HLA-matched related donor, donor sources such as haplo-identical (Haplo) relatives or cord blood (UCB) represent reasonable alternatives. There is currently little data on the outcome of TCL patients undergoing alternative donor transplantation. The Société Francophone de Greffe de Moelle et de Transplantation Cellulaire (SFGM-TC) conducted this study to evaluate the outcome of recipients of alternate donor allo-SCT for TCL. Methods. 95 patients with non epidermotropic TCL, transplanted between 2003 and 2017, reported to ProMISE (Project Manager Internet Server), an internet-based system shared by 36 Francophone transplantation centers, were reviewed. Comparisons of outcome after transplants from different donors (Haplo, n=41 vs UCB, n=54) were performed with regard to overall survival (OS), non-relapse mortality (NRM), relapse and acute/chronic graft-versus-host disease (aGVHD/cGVHD) incidence. Results. Patients' characteristics are detailed in Table 1. Median age at HSCT was 42.5 (range, 3.6 - 68) years, with an older cohort for the Haplo group (50.7 vs 33.6 for UCB, p< .001). Except for the median year of transplantation (median year 2017 for Haplo vs 2010 for UCB,) and the myeloablative regimen (22% for Haplo vs 48% for UCB, p .009), both Haplo and UCB groups were comparable concerning interval from diagnosis to HSCT, donor/recipient CMV status, sex and ABO mismatch. Patients received a median of 2 (range, 1-5 for Haplo; 1-6 for UCB) therapeutic lines. Twenty-eight (10 in Haplo vs 18 in UCB, p NS) underwent auto- or allo-SCT prior to Haplo or UCB-HSCT. Median time to engraftment was shorter (19 vs 25 days, p .025) in Haplo recipients. According to donor type, no differences were found in univariate analysis for the CI of grade II-IV aGVHD (35% vs 35%, p .88) and cGVHD (30% vs 28%, p .49). Median follow-up was 24 months and 47 months for Haplo and UCB recipients, respectively (p .004). At 12 months, OS was 71% and 50% (p .033), progression-free survival (PFS) 63% and 44% (p .045) and NMR 7% and 26% (p .014) in HSCT from Haplo and UCB, respectively. Relapse incidence was similar following HSCT from Haplo and UCB (32% vs 31%). Conclusion. Based on these first results, our study suggests that Haplo-HSCT is a strategy achieving prolonged survival as compared to UCB donors, due to less toxicity and similar incidence of relapse. An analysis of influencing factors will be further detailed. Figure Disclosures Blaise: Jazz Pharmaceuticals: Honoraria; Pierre Fabre medicaments: Honoraria; Molmed: Consultancy, Honoraria; Sanofi: Honoraria. Socie:Alexion: Consultancy. Mohty:Jazz Pharmaceuticals: Honoraria, Research Funding. Robin:Novartis Neovii: Research Funding.

scholarly journals Plerixafor for Autologous Peripheral Blood Stem Cell Mobilization in Patients Previously Treated with Fludarabine or Lenalidomide

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1932-1932
Author(s):  
Florent Malard ◽  
Nicolaus Kröger ◽  
Ian H Gabriel ◽  
Kai Hübel ◽  
Jane F. Apperley ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hodgkin Lymphoma ◽  
Peripheral Blood ◽  
Median Number ◽  
Stem Cell Mobilization ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Previously Treated ◽  
Cell Mobilization ◽  
Autologous Hsct

Abstract Abstract 1932 High dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) is an effective treatment for patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). At present, G-CSF-mobilized peripheral blood stem cells (PBSCs) are the preferred stem cell source for autologous HSCT. Fludarabine and lenalidomide are essential drugs in the front line treatment of NHL and MM respectively. Data suggests that fludarabine and lenalidomide therapy may have a deleterious effect on stem cell mobilization. Prior to the drug approval in Europe, a plerixafor compassionate use program (CUP) was available from July 2008 to August 2010 to provide access to the drug for patients with MM or lymphoma who had previously failed a mobilization attempt, and who were not eligible for another specific plerixafor trial. In the European CUP, 48 patients (median age 57 years; range, 36–69), previously treated with fludarabine (median 5 cycles; range, 1–7 cycles) were given plerixafor plus G-CSF for remobilization following a primary mobilisation attempt. All 48 patients had a diagnosis of NHL. The overall median number of CD34+ cells collected was 2.3×106 /Kg (range, 0.3–13.4). The minimum required number of CD34+ cells (≥2.0×106 per kg) was collected from 58% of patients, while only 3 patients (6%) collected ≥5.0×106 CD34+ cells. The collection target of 2.0×106/Kg was reached in a median of 2 apheresis sessions (range, 1–3). Thirty-five patients (median age 57 years; range, 34–66), previously treated with lenalidomide (median 5 cycles; range, 1–10 cycles) were given plerixafor plus G-CSF for remobilization. All patients the 35 patients had MM. The overall median number of CD34+ cells collected was 3.4×106/Kg (range, 1.1–14.8). The minimum required number of CD34+ cells (≥2.0×106 per kg) was collected from 69% of patients, including 12 patients (34%) who were able to collect ≥5.0×106 cells/Kg. In the Len group, 7 patients (20%) had received a prior autologous HSCT before salvage mobilization with plerixafor. Both targets were reached with a median of 2 apheresis sessions (range, 1–4). In conclusion, salvage mobilization with plerixafor plus G-CSF is successful in the majority of patients with MM previously treated with lenalidomide. In fludarabine-exposed patients, only 58% of patients will achieve successful salvage mobilization with plerixafor plus G-CSF, suggesting the need for large prospective studies evaluating the efficacy of plerixafor for frontline mobilization in this subgroup of patients.Table 1.Study population characteristicsCharacteristic (%)Fludarabine (N=48)Lenalidomide (N=35)Patient age, median (range)57 (36–69)57 (34–66)Patient gender    Male26 (54)18 (51)    Female22 (46)17 (42)Fludarabine or Lenalidomide cycles, median (range)5 (1–7)5 (1–10)Diagnosis and disease statusIndolent NHL48 (100)0 (0)Multiple myeloma0 (0)35 (100)Previous chemotherapy: number of lines, median (range)3 (1–6)4 (1–9)Previous autograft    Yes07 (20)    No43 (90)20 (57)    Data missing5 (10)8 (23)Radiotherapy    Yes5 (10)3 (9)    No36 (75)24 (68)    Data missing7 (15)8 (23)Mobilization strategy with plerixafor    Steady-state GCSF mobilization38 (79)27 (77)    Chemotherapy+GCSF mobilization10 (21)8 (23)No. of patients collected44 (92)34 (97)CD34+ cells collected per Kg, median (range)2.3 (0.3–13.4)3.4 (1.1–14.8)No. of patients who reached ≥ 2.106 CD34+28 (58)24 (69)No. of apheresis days to reach ≥ 2.106 CD34+2 (1–3)2 (1–4)No. of patients who reached ≥ 5.106 CD34+3 (6)12 (34)No. of apheresis days to reach ≥ 5.106 CD34+2 (1–3)2 (1–3)NHL, non-Hodgkin lymphoma Disclosures: Mohty: Genzyme: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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