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Lunning MA, Wang HL, Hu ZH, Locke FL, Siddiqi T, Jacobson CA, Ahmed S, Miklos DB, Lin Y, Hill BT, Ghobadi A, Neelapu SS, Westin J, Dieyi C, Field P, Miao H, Shahani SA, Patel A, Spooner C, Fu C, Muramoto D, Xu H, Pasquini MC. Benefit of axicabtagene ciloleucel versus chemoimmunotherapy in older patients and/or patients with poor ECOG performance status with relapsed or refractory large B-cell lymphoma after 2 or more lines of prior therapy. Am J Hematol 2024; 99:880-889. [PMID: 38504387 DOI: 10.1002/ajh.27283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
Axicabtagene ciloleucel (axi-cel) in trials has demonstrated favorable efficacy compared with historical controls after ≥2 lines of therapy for the treatment of relapsed or refractory (R/R) large B cell lymphoma (LBCL). Herein, we compared the real-world effectiveness of axi-cel with efficacy and effectiveness of chemoimmunotherapy (CIT) in patients aged ≥65 years and patients with Eastern Cooperative Oncology Group performance status (ECOG PS) of 2. A total of 1146 patients treated with commercial axi-cel for R/R LBCL with ≥2 lines of prior therapy were included from the Center for International Blood and Marrow Transplantation Research prospective observational study, and 469 patients treated with CIT for R/R LBCL after ≥2 lines of prior therapy were included from SCHOLAR-1 (an international, multicohort, retrospective study). After propensity score matching, at a median follow-up of 24 months for patients receiving axi-cel and 60 months for patients receiving CIT, 12-month overall survival rates were 62% and 28%, respectively (hazard ratio, 0.30 [95% CI, 0.24-0.37]). Objective response rate (ORR) was 76% (complete response [CR] rate 58%) in patients receiving axi-cel versus 28% (CR rate 16%) for those receiving CIT. A 57% difference in ORR (55% difference in CR rate) favoring axi-cel over CIT was observed among patients aged ≥65 years. Increased magnitude of benefit in response rates for axi-cel versus CIT was also observed among patients with ECOG PS = 2. These findings further support the broader use of axi-cel in older patients and patients with ECOG PS = 2 with R/R LBCL.
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Affiliation(s)
| | - Hai-Lin Wang
- Kite, A Gilead Company, Santa Monica, California, USA
| | - Zhen-Huan Hu
- Kite, A Gilead Company, Santa Monica, California, USA
| | | | - Tanya Siddiqi
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Sairah Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David B Miklos
- Stanford University School of Medicine, Stanford, California, USA
| | - Yi Lin
- Mayo Clinic, Rochester, Minnesota, USA
| | - Brian T Hill
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Armin Ghobadi
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Sattva S Neelapu
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason Westin
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Harry Miao
- Kite, A Gilead Company, Santa Monica, California, USA
| | | | - Anik Patel
- Kite, A Gilead Company, Santa Monica, California, USA
| | - Clare Spooner
- Kite, A Gilead Company, Santa Monica, California, USA
| | - Christine Fu
- Kite, A Gilead Company, Santa Monica, California, USA
| | | | - Hairong Xu
- Kite, A Gilead Company, Santa Monica, California, USA
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2
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Wudhikarn K, Johnson BM, Inwards DJ, Porrata LF, Micallef IN, Ansell SM, Hogan WJ, Paludo J, Villasboas JC, Johnston PB. Outcomes of Older Adults with Non-Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplantation: A Mayo Clinic Cohort Analysis. Transplant Cell Ther 2023; 29:176.e1-176.e8. [PMID: 36563788 DOI: 10.1016/j.jtct.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an important treatment that can offer a cure for patients with lymphoma. However, advanced age is an important factor that determines eligibility and outcomes after ASCT. Over the past decade, attributed to improved supportive care, ASCT for older patients has become more feasible. In this study, we report the single-center outcomes of older patients with lymphoma undergoing ASCT at Mayo Clinic Rochester to highlight its interval improvement over time and to help redefine the implications of ASCT in the chimeric antigen receptor T cell therapy era. This single-center retrospective study evaluated the characteristics and outcomes of older patients with lymphoma who underwent ASCT between 2000 and 2021. We report various relevant transplantation-related outcomes, including progression-free survival, overall survival (OS), relapse incidence, and nonrelapse mortality (NRM) in older patients with various lymphoma histologic subtypes. The main outcome was NRM, defined as the time from ASCT to non-lymphoma-related death, with relapse as a competing event. Of 492 patients age ≥65 years were analyzed. The median age at ASCT was 68.8 years. The most common indication for ASCT was diffuse large B cell lymphoma, accounting for 59.3% of cases. In multivariate analyses, patients undergoing ASCT in 2009 to 2021, an Eastern Cooperative Oncology Group Performance Status of 0, and low Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) (0 to 3) had a significantly lower NRM. Factors associated with OS included age, lactate dehydrogenase level, and HCT-CI. The 1-year NRM in older patients was low at 6.0%, in concordance with previous reports. Age should not be the sole factor determining a patient's ASCT eligibility. With the proper patient selection, ASCT remains a reasonable option for older patients with lymphoma.
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Affiliation(s)
- Kitsada Wudhikarn
- Division of Hematology, Mayo Clinic, Rochester, Minnesota; Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bradley M Johnson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Luis F Porrata
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Willam J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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Liu J, Wang H, Li X, Wu Y, Ma Y, Gu Z, Li F, Li M, Guo J, Zhao Y, Wang Q, Bo J, Huang W, Dou L, Liu Y, Liu D, Wu X, Gao C. Impact of Autologous Stem Cell Transplantation on Primary Central Nervous System Lymphoma in First-Line and Relapse Settings: A Retrospective Study in China. Ann Transplant 2023; 28:e938467. [PMID: 36593744 PMCID: PMC9825020 DOI: 10.12659/aot.938467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myeloablative chemotherapy supported by autologous stem cell transplantation (ASCT) is an option for primary central nervous system lymphoma (PCNSL) in both the relapse setting and as postremission consolidation, but the level of evidence in this field is still low. MATERIAL AND METHODS We retrospectively analyzed 47 HIV-negative PCNSL patients from 2010 to 2021. To assess the outcomes in patients undergoing ASCT. RESULTS Of the 47 patients, the median age was 51 (range, 21-77) years, and 28 (59.6%) were male. After induction, 33 (70.2%) patients achieved complete remission, and 6 (12.8%) patients achieved partial remission. At a median follow-up of 21.4 months (95% CI 8.86-33.95), the median progression-free survival (PFS) was 23.3 months (95% CI 14.87-31.73), and the 4-year PFS rate was 14.6%. The median overall survival (OS) time was 62.4 months (95% CI 41.93-82.87), and the 4-year OS rate was 71.5%. Among 20 patients who received ASCT (10 consolidation, 10 salvage), the 4-year PFS and 4-year OS rates were 57.3% and 71.2%, respectively. In the multivariate analysis, ASCT therapy (hazard ratio [HR] 0.16, P=0.016) and early remission (HR 0.12, p=0.003) were found to be independent prognostic factors for a longer PFS. Two treatment-related deaths occurred in patients with multiple relapses before ASCT. Pancytopenia and diarrhea were the most common adverse events. CONCLUSIONS ASCT offers potential long-term PFS with good tolerability for patients with PCNSL. Our retrospective cohort adds to the currently available literature and identifies disease status after induction as a significant factor affecting survival.
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Affiliation(s)
- Jing Liu
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Haitao Wang
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Xiaohong Li
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Yamei Wu
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Yuanyuan Ma
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Zhenyang Gu
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Fei Li
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Meng Li
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Jiayuan Guo
- Department of Hematology, School of Medicine, Nankai University, Tianjin, PR China
| | - Yu Zhao
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Quanshun Wang
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Jian Bo
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Wenrong Huang
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Liping Dou
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Daihong Liu
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Xiaoxiong Wu
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Chunji Gao
- Department of Hematology, The Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, PR China
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Parody R, Sánchez-Ortega I, Mussetti A, Patiño B, Arnan M, Pomares H, González-Barca E, Mercadal S, Boqué C, Maluquer C, Carro I, Peña M, Clapés V, Verdesoto S, Bustamante G, Oliveira AC, Baca C, Cabezudo E, Talarn C, Escoda L, Ortega S, García N, Isabel González-Medina M, Sánchez-Salmerón M, Fusté C, Villa J, Carreras E, Domingo-Domènech E, Sureda A. A real-life overview of a hematopoietic cell transplant program throughout a four-year period, including prospective registry, exclusion causes and final donor selection. Bone Marrow Transplant 2021; 57:176-182. [PMID: 34711917 DOI: 10.1038/s41409-021-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022]
Abstract
Traceability of patients who are candidates for Hematopoietic cell transplant (HCT) is crucial to ensure HCT program quality. Continuous knowledge of both a detailed registry from a HCT program and final exclusion causes can contribute to promoting a real-life vision and optimizing patient and donor selection. We analyzed epidemiological data reported in a 4 year-monocentric prospective registry, which included all patients presented as candidates for autologous (Auto) and/or allogeneic (Allo) HCT. A total of 543 patients were considered for HCT: 252 (42.4%) for Allo and 291 (57.6%) for Auto. A total of 98 (38.9%) patients were excluded from AlloHCT due to basal disease progression more commonly (18.2%). Seventy-six (30.2%) patients had an HLA identical sibling, whereas 147 (58.3%) patients had only Haplo. UD research was performed in 106 (42%) cases, significantly more often in myeloid than lymphoid malignancies (57% vs 28.7%, p < 0.001) but 61.3% were finally canceled, due to donor or disease causes in 72.4%. With respect to Auto candidates, a total of 60 (20.6%) patients were finally excluded; progression was the most common cause (12%). Currently, Haplo is the most frequent donor type. The high cancellation rate of UD research should be revised to optimize further donor algorithms.
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Affiliation(s)
- R Parody
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain. .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
| | - I Sánchez-Ortega
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A Mussetti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - B Patiño
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - M Arnan
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - H Pomares
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - E González-Barca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - S Mercadal
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Boqué
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Maluquer
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - I Carro
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - M Peña
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - V Clapés
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H. Comarcal d'Alt Penedés, Vilafranca del Penedés, Barcelona, Spain
| | - S Verdesoto
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - G Bustamante
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A C Oliveira
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Hospital Sant Camil - St. Pere de Ribes, Barcelona, Spain
| | - C Baca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H General de Igualada, Barcelona, Spain
| | - E Cabezudo
- EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - C Talarn
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - L Escoda
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - S Ortega
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | - N García
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | | | - Mar Sánchez-Salmerón
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - C Fusté
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - J Villa
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Carreras
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Domingo-Domènech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
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Hematopoietic-cell transplantation for lymphoma in the era of genetically engineered cellular therapy: it's not quite time to scrap the old vehicle for the new car. Curr Opin Hematol 2019; 26:288-293. [PMID: 31170111 DOI: 10.1097/moh.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Second-line platinum-based salvage chemotherapy followed by high-dose chemotherapy and autologous hematopoietic-cell transplantation (AHCT) has remained the standard of care (SOC) for relapsed and primary refractory (r/r) diffuse large B-cell lymphoma (DLBCL) for greater than 2 decades. In the postrituximab era, this strategy has yielded disappointing outcomes for r/r patients with curability in less one-quarter of the patients by intention-to-treat. RECENT FINDINGS Given the Food and Drug Administration (FDA) approval of chimeric antigen receptor (CAR) modified T cells directed against CD19 (CD19 CAR T) for DLBCL following two lines of therapy and/or failed AHCT, encouragement with this therapy in the second line for r/r patients has naturally prompted randomized phase III studies against the aforementioned SOC. The predominant hurdle to procession to AHCT is chemotherapy sensitivity after platinum-based salvage therapy. SUMMARY In this review, we will discuss recent investigations to improve response rates in r/r DLBCL with the intent of proceeding to potentially curative AHCT, as well as investigations to decrease progression post-AHCT. In addition, data regarding currently FDA approved CD19 CAR T cells will be reviewed. Within 2-3 years, we will know if the multicenter/multinational studies of CD19 CAR T will replace SOC salvage therapy and AHCT in the second-line. The role of allogeneic HCT will also be briefly reviewed in the context of these therapies.
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6
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Gaut D, Schiller GJ. Hematopoietic stem cell transplantation in primary central nervous system lymphoma: a review of the literature. Int J Hematol 2019; 109:260-277. [PMID: 30671909 DOI: 10.1007/s12185-019-02594-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 12/26/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma (NHL) with an aggressive course and worse outcomes compared with other lymphomas of similar tumor burden and histologic subtype. High-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT) is an option for therapy for this disease in both the relapse setting and as post-remission consolidation. Data are currently limited to only several single-arm phase II trials with small sample sizes, but randomized trials are now ongoing. In this review, we discuss the efficacy, feasibility, and toxicity of HDC/ASCT for PCNSL and its role in the treatment of this aggressive malignancy, both in the first-line and relapse settings. We also bring to attention the current data on allogeneic stem cell transplantation (allo-SCT) in PCNSL.
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Affiliation(s)
- Daria Gaut
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Gary J Schiller
- Hematological Malignancies/Stem Cell Transplantation Unit, Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Room 42-121 CHS, Los Angeles, CA, 90095, USA.
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7
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Davison K, Chen BE, Kukreti V, Couban S, Benger A, Berinstein NL, Kaizer L, Desjardins P, Mangel J, Zhu L, Djurfeldt MS, Hay AE, Shepherd LE, Crump M. Treatment outcomes for older patients with relapsed/refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: a subgroup analysis from the phase III CCTG LY.12 trial. Ann Oncol 2017; 28:622-627. [PMID: 27993811 DOI: 10.1093/annonc/mdw653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background High-dose therapy and autologous stem cell transplantation (ASCT) is often considered for older patients (age >60 years) with relapsed/refractory aggressive lymphomas. Although registry data support the safety and potential efficacy of this approach, there are no prospective trials evaluating outcomes of ASCT in older patients. We evaluated the result of second-line chemotherapy and ASCT in older versus younger patients in the CCTG randomized LY.12 trial. Patients and methods From August 2003 to November 2011, 619 patients with relapsed/refractory aggressive lymphoma were randomized to gemcitabine, dexamethasone, cisplatin (GDP) or dexamethasone, cytarabine, cisplatin (DHAP); 177 patients (28.6%) enrolled were >60.0 years of age (range, 60-74) and 442 were ≤60.0 years of age. After two to three cycles, responding patients proceeded to ASCT. Intention-to-treat analysis was used to compare response rate, transplantation rate, event-free survival (EFS) and overall survival (OS) between patients aged ≤60.0 and >60.0 years. Results Patient characteristics were comparable between the two cohorts, except a larger proportion of older patients had high International Prognostic Index risk scores. Response to salvage therapy was 48.6% for patients aged >60.0 versus 43.0% for those aged ≤60.0 (P = 0.21). Transplantation rates were also similar: 50.3% versus 49.8% (P = 0.87) for older versus younger patients. Rates of febrile neutropenia and adverse events requiring hospitalization were comparable for older and younger patients (30.5% versus 22.9% and 37.9% versus 32.1%, respectively). With a median follow-up of 53 months, there was no difference in 4-year OS (36% and 40% for patients aged >60.0 and ≤60.0 years, P = 0.42), or 4-year EFS (20% versus 28%, P = 0.43). Mortality from salvage therapy was 8/174 (4.60%) and 5/436 (1.15%), and 100-day mortality post-ASCT was 7/88 (8.06%) and 4/219 (1.85%). Conclusion This subgroup analysis suggests that older patients derive similar benefit from salvage therapy and ASCT to younger patients, with acceptable toxicity. ClinicalTrials.gov Identifier NCT00078949.
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Affiliation(s)
- K Davison
- Division of Hematology, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
| | - B E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - V Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - S Couban
- Division of Hematology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - A Benger
- Division of Malignant Hematology, Department of Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - N L Berinstein
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - L Kaizer
- Division of Oncology, Department of Medicine, Credit Valley Hospital, Mississauga, Canada
| | - P Desjardins
- Division of Hematology, Department of Medicine, Hôpital Charles LeMoyne, Longueuil, Canada
| | - J Mangel
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Canada
| | - L Zhu
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - M S Djurfeldt
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - A E Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - L E Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - M Crump
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
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8
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Dogu MH, Çagirgan S, Ocakci S, Kaya AH, Ilkkilic K, Sanli NM, Kahraman S, Eren R, Tekgunduz E, Hacioglu S, Kaynar L, Erkurt MA, Altuntas F. Autologous stem cell transplantation and stem cell mobilization kinetics in elderly patients with B cell non-Hodgkin lymphoma. Transfus Apher Sci 2017; 56:814-818. [PMID: 29153347 DOI: 10.1016/j.transci.2017.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As known, the world population is aging and as the life span increases the number of advanced-age lymphomas also shows an upward trend. Autologous hematopoietic stem cell transplantation (HSCT) is the standard treatment modality in chemotherapy-sensitive relapsed or refractory aggressive lymphomas. Increased morbidity and mortality related to both the transplant itself and comorbid diseases can be observed in elderly lymphoma patients. Patients who are 65 years or older and underwent autologous HSCT with B-cell non-Hodgkin lymphoma were retrospectively included in our study. In terms of survival analysis, median follow-up was 34.5 months (8-159) while the overall survival (OS) was 58%. In the univariate analysis of prognostic data in OS, patients who were referred to transplantation with complete response had a statistically significant survival advantage (p=0.043). In terms of the effect of pre-transplant conditioning regimens on survival, BEAM regimen yielded better results, though not statistically significant. Age, number of chemotherapy cycles received before mobilization and radiation therapy had no significant effect on the CD34 (+) cell count in the final product (p=0.492, 0.746 and 0.078 respectively). In conclusion, autologous HSCT is a practicable treatment modality that provides survival advantage in suitable advanced-age patients with a diagnosis of B-cell non-Hodgkin lymphoma.
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Affiliation(s)
- Mehmet Hilmi Dogu
- Istanbul Training and Research Hospital, Hematology Clinic, Istanbul, Turkey.
| | - Seçkin Çagirgan
- Medical Park Izmir Hospital, Department of Hematology, Izmir, Turkey
| | - Serkan Ocakci
- Medical Park Izmir Hospital, Department of Hematology, Izmir, Turkey
| | - Ali Hakan Kaya
- Ankara Oncology Training and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Kadir Ilkkilic
- Pamukkale University Faculty of Medicine, Department of Hematology, Denizli, Turkey
| | | | - Selda Kahraman
- Medical Park Izmir Hospital, Department of Hematology, Izmir, Turkey
| | - Rafet Eren
- Istanbul Training and Research Hospital, Hematology Clinic, Istanbul, Turkey
| | - Emre Tekgunduz
- Ankara Oncology Training and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Sibel Hacioglu
- Pamukkale University Faculty of Medicine, Department of Hematology, Denizli, Turkey
| | - Leylagul Kaynar
- Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
| | - Mehmet Ali Erkurt
- Inonu University Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Fevzi Altuntas
- Ankara Oncology Training and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey; Yildirim Beyazit University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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9
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Joffe E, Rosenberg D, Rozovski U, Perry C, Kirgner I, Trestman S, Gur O, Aviv F, Sarid N, Kolomansky A, Gepstein L, Herishanu Y, Naparstek E. Replacing carmustine by thiotepa and cyclophosphamide for autologous stem cell transplantation in Hodgkin's and non-Hodgkin's B-cell lymphoma. Bone Marrow Transplant 2017; 53:29-33. [PMID: 29035395 DOI: 10.1038/bmt.2017.205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/18/2017] [Accepted: 08/12/2017] [Indexed: 11/09/2022]
Abstract
This study aimed to compare the real-life results of TECAM, a thiotepa-based conditioning regimen consisting of thiotepa (40 mg/m2 days -5 to -2), etoposide (200 mg/m2 days -6 to -3), cytarabine (200 mg/m2 days -4 to -1), cyclophosphamide (60 mg/kg day -3), and melphalan (60 mg/m2 days -2 to -1) with that of the conventional carmustine-based regimen BEAM. We reviewed 125 consecutive patients who underwent a first autologous transplantation (ASCT) for B-cell lymphomas at a large tertiary transplantation center between 1999 and 2014. TECAM (n=65) and BEAM (n=60) had comparable results (3yPFS 49 vs 62%, P=0.16; 3yOS 64 vs 71%, P=0.44; TRM 1.6 vs 5%, P=0.35) without a difference in toxicity or time to engraftment. Notably, comparable outcomes were observed even though patients treated with TECAM were older (55 vs 44) and had a trend towards more prior lines of therapy (>2 prior lines: 43 vs 27%, P=0.08). In this regard, 23% of TECAM patients were over the age of 65 yet could withstand therapy with similar results to younger patients. We conclude that, replacing carmustine by thiotepa and cyclophosphamide for ASCT conditioning, has comparable efficacy and safety profiles with a possible advantage in older patients.
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Affiliation(s)
- E Joffe
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Rabin Medical Center, Petah-Tikva, Israel
| | - D Rosenberg
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Rabin Medical Center, Petah-Tikva, Israel
| | - U Rozovski
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Rabin Medical Center, Petah-Tikva, Israel
| | - C Perry
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - I Kirgner
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - S Trestman
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - O Gur
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - F Aviv
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - N Sarid
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - A Kolomansky
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - L Gepstein
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Y Herishanu
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - E Naparstek
- Tel Aviv University Sackler School of Medicine, Tel-Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
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10
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Arboe B, Halgren Olsen M, Duun-Henriksen AK, Gørløv JS, Nielsen KF, Thomsen RH, Madsen C, Nielsen SR, Dalton SO, Brown PDN. Prolonged hospitalization, primary refractory disease, performance status and age are prognostic factors for survival in patients with diffuse large B-cell lymphoma and transformed indolent lymphoma undergoing autologous stem cell transplantation. Leuk Lymphoma 2017; 59:1153-1162. [DOI: 10.1080/10428194.2017.1369061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Bente Arboe
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Jette Sønderskov Gørløv
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
| | | | - Rasmus Heje Thomsen
- Department of Hematology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Charlotte Madsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter de Nully Brown
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
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11
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Stiff P. What is the role of autologous transplant for lymphoma in the current era? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:74-81. [PMID: 26637704 DOI: 10.1182/asheducation-2015.1.74] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The role of autologous hematopoietic stem cell transplantation (ASCT) in the management of non-Hodgkin's lymphoma (NHL) is evolving, in the era of novel agents. Multiple histologies and remission stages have been impacted with changing outcomes. In the 1990s, ASCT could cure 50% of relapsed chemosensitive aggressive NHL; now the percentage maybe as low as 20% for patients relapsing within 1 year of completing rituximab-containing induction. Yet recent trials have clarified the value of first remission ASCT for high-grade NHL, the utility of augmented preparative regimens, the efficacy of ASCT in primary CNS lymphoma and in the elderly and analyses have defined strategies to reduce transplant related myeloid malignancies. In addition, optimizing nontransplant induction therapy for mantle cell and double-hit NHL is leading to improved outcomes and a re-examination of the use of ASCT in first complete remission. Caution is needed, however, as delaying transplants may mean that patients will need more morbid allogeneic transplants to achieve long-term control of refractory disease. As an alternative, maintenance therapy trials to improve ASCT outcome in high-risk patients are starting, based on the efficacy of lenolidomide and brentuximab in myeloma and Hodgkin's lymphoma, respectively. In addition, efforts to define early high-risk patients by minimal residual disease (MRD) assessments and genetic profiling, are beginning even for those with "indolent" phenotypes not currently autotransplanted. These efforts should not only refine but also enhance the value of early potentially curative ASCT, especially if novel agents only delay but do not prevent relapse for patients with NHL.
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Affiliation(s)
- Patrick Stiff
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL
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