Faculty Opinions recommendation of High-dose therapy and autologous peripheral blood stem cell transplantation as salvage treatment for AIDS-related lymphoma: long-term results of the Italian Cooperative Group on AIDS and Tumors (GICAT) study with analysis of prognostic factors.

AbstractAfter the introduction of highly active antiretroviral therapy (HAART), intensive treatment, including high-dose therapy (HDT) and peripheral blood stem cell transplantation (PBSCT), has become feasible in HIV-positive patients with Hodgkin (HL) and non-Hodgkin (NHL) lymphoma. Herein, we report the long-term results, on an intention-to-treat basis, of a prospective study on HDT and PBSCT in 50 HIV-positive HAART-responding patients with refractory/relapsed lymphoma. After debulking therapy, 2 patients had early toxic deaths, 10 had chemoresistant disease, 6 failed stem cell mobilization, 1 refused collection, and 4 progressed soon after PBSC harvest. Twenty-seven actually received transplant. Twenty-one patients are alive and disease-free after a median follow-up of 44 months (OS, 74.6%; PFS, 75.9%). Only lymphoma response significantly affected OS after transplantation. In multivariate analyses both lymphoma stage and low CD4 count negatively influenced the possibility to receive transplant. Median OS of all 50 eligible patients was 33 months (OS, 49.8%; PFS, 48.9%). Low CD4 count, marrow involvement, and poor performance status independently affected survival. PBSCT is a highly effective salvage treatment for chemosensitive AIDS-related lymphoma. It seems rational to explore its use earlier during the course of lymphoma to increase the proportion of patients who can actually receive transplant.

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High-dose therapy with peripheral blood stem cell transplantation for patients with relapsed or refractory Hodgkin's disease: long-term outcome and prognostic factors

Annals of Hematology ◽

10.1007/s002770000190 ◽

2000 ◽

Vol 79 (10) ◽

pp. 547-555 ◽

Cited By ~ 4

Author(s):

K. Neben ◽

S. Hohaus ◽

H. Goldschmidt ◽

G. Egerer ◽

M. T. Voso ◽

...

Keyword(s):

Stem Cell ◽

Prognostic Factors ◽

Stem Cell Transplantation ◽

Peripheral Blood Stem Cell ◽

High Dose ◽

High Dose Therapy ◽

Term Outcome ◽

Long Term Outcome ◽

Blood Stem Cell Transplantation

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Reduced-Intensity Conditioning for Allograft (RICT) after Cytoreductive Autograft (ASCT) in Relapsed/Resistant Hodgkin’s Lymphoma (HL)

Blood ◽

10.1182/blood.v112.11.3294.3294 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3294-3294

Author(s):

A. M. Carella ◽

E. Todisco ◽

L. Castagna ◽

A. Santoro ◽

G. Catania ◽

...

Keyword(s):

Prognostic Factors ◽

Complete Remission ◽

Long Term Results ◽

High Dose ◽

Reduced Intensity Conditioning ◽

High Dose Therapy ◽

Previous Therapy ◽

Reduced Intensity

Abstract Reduced-intensity conditioning for transplant (RICT) aims to exploit graft vs lymphoma (GvLy) effects while reducing conditioning-related toxicity. Because GvLy responses might be insufficient when HL are bulky and lymphoma growth is rapid, we pionered that intensive cytoreduction prior to RICT may allow GvLy reaction to be exploited (Carella et al. JCO2000; 18:3918). Thirty-eight patients with relapsed (n=26) or refractory (n=12) HL underwent RICT from an HLA-identical sibling preceeded by ASCT. Previous therapy consisted of 2–6 lines. High-dose therapy with ASCT consisted of BEAM protocol (n=29) or melphalan 200 mg/m2 (n=9). RICT consisted of fludarabine-cyclophosphamide (n=30) or fludarabine-melphalan (n=8). The two groups had similar prognostic factors. The median time to neutrophils and platelets recovery was 10 days and 16 days, respectively. Chimerism studies indicated 100% donor-derived engraftment. Day 100 and cumulative (2 yrs) TRM were 5,3 % (2 pts) and 18% (7 pts), respectively. Seventeen patients (44%) are alive (12 in complete remission and 5 with stable disease) with a median follow-up of 41 months (7–110 months). Twenty-one patients expired (TRM n=7, disease progression n=14). In conclusion, tandem ASCT/RICT is feasible and effective salvage therapy for patients with advanced HL. The long-term results obtained appear encouraging.

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High Dose Therapy and Autologous Peripheral Blood Stem Cell Transplantation as Salvage Therapy for HIV-Associated Lymphoma: Result of the GICAT Study.

Blood ◽

10.1182/blood.v110.11.23.23 ◽

2007 ◽

Vol 110 (11) ◽

pp. 23-23 ◽

Cited By ~ 1

Author(s):

Alessandro Re ◽

Mariagrazia Michieli ◽

Chiara Cattaneo ◽

Maurizio Rupolo ◽

Salvatore Casari ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Peripheral Blood ◽

Peripheral Blood Stem Cell ◽

Stage Iv ◽

Salvage Treatment ◽

High Dose ◽

High Dose Therapy ◽

Blood Stem Cell Transplantation ◽

Grade Iii

Abstract The introduction of highly active antiretroviral therapy (HAART) has allowed the use of intensive treatments for HIV+ patients (pts) with malignancies. In 2000 we started a multiinstitutional prospective study of high dose therapy (HDT) and autologous peripheral blood stem cell transplantation (PBSCT) as salvage treatment for HAART responding HIV+ pts with primary refractory or relapsed Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Aim of the study was to test both the feasibility and efficacy in unselected pts. Pts showing chemoresistance or progressive disease (PD) during debulking treatment or failing PBSC collection were excluded and analysed according to the intention to treat. From May 2000 to Feb 2007 50 pts entered the study. 31 had NHL and 19 HL (20 refractory disease, 5 partial remission (PR), 22 first and 3 second relapse); median age was 39 (28–59); 60% stage IV disease; CD4 count was 218/mcl (17–561) and 11 pts had CD4 < 100; 22% had detectable HIV-viremia. Pts first received debulking chemotherapy (CT) at discretion of centers (2–4 courses): 2 died from toxicity and 10 had PD; 1 pt retracted and 6 failed PBSC mobilization. In 31 pts CD34+cells were collected (median 5.9x10e6/kg), after Cyclophosphamide 4g/mq + G-CSF (12 pts) or at recovery after CT (19 pts). Four pts had early PD and 27 received HDT (BEAM) according to the protocol (median time to N and PLT engraftment was 10 and 12 days). 10 pts underwent consolidation radiotherapy. Pts received HAART during the entire program (in 7 a brief discontinuance was necessary). Treatment toxicity was mainly gastrointestinal (8 grade III mucositis/enteritis and 1 grade IV mucositis) and hepatic (2 grade III). There were 9 FUO and 2 sepsis (S.epidermidis and E.coli), 1 Clostridium colitis, 1 Ps. aeruginosa pneumonia and 2 reactivation of perianal abscess. Infections in the first 2 years included 6 HZ, 2 esophagus candidosis, 1 CMV corioretinitis and 4 CMV reactivation with no disease. The CD4 count decreased after PBSCT (median 190.5/mcl pre PBSCT and 119.5 at +3), with recovery after few ms (157 at +6 and 285.5 at +12). 3 pts had PD after PBSCT (2 after a brief PR) and 3 relapsed after complete remission (CR) at +5, +8 and +12. 21 of 27 pts are alive and disease free (17 CR and 4 CRu), after a f-up of 44 mo (2–70), (OS 74% and PFS 75%). The median survival of the entire series (50 pts) from the enrolment was 33 ms with an OS of 49% and a PFS of 50% (follow-up 45 ms). Ann Arbor stage IV and CD4 <100/mcl were associated with a worse prognosis (stage IV vs Stage < IV: OS 35% vs 72%;P=.003; CD4 < 100 vs > 100: OS 18% vs 59%;P=.001). Pts enrolled with PR or relapse had an OS of 62% compared with 32% of pts primary refractory (P=0.09). This study confirms on a large series the feasibility of HDT and PBSCT in HIV+ pts and shows its high long-term efficacy as salvage treatment in HIV-associated lymphoma. Less than 50% of pts couldn’t benefit this procedure, mainly because of advanced disease or severe immunodeficiency; earlier use of HDT in the course of their disease could be advisable.

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