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Autologous stem cell transplantation as bridging therapy followed by CD19 CAR-T cells in relapsed-refractory large B cell lymphoma. Bone Marrow Transplant 2022; 57:837-839. [PMID: 35260803 DOI: 10.1038/s41409-022-01632-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022]
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2
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Metzner B, Welzel J, Müller TH, Casper J, Kimmich C, Petershofen EK, Renzelmann A, Rosien B, Thole R, Voss A, Willborn K, Köhne CH. Long-term remissions in patients with early relapse of diffuse large B-cell lymphoma following high-dose chemotherapy, autologous stem cell transplantation, and radiotherapy of residual disease. Strahlenther Onkol 2021; 198:39-46. [PMID: 34735577 DOI: 10.1007/s00066-021-01868-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The prognosis of an early relapse of diffuse large B-cell lymphoma (DLBCL) appears to be poor following autologous stem cell transplantation (ASCT). The aim of this study is to contribute data to the open question on whether additional radiotherapy can improve the outcome. PATIENTS AND METHODS Forty-eight patients with an early relapse (median 4 months after the end of initial immunochemotherapy, range 1-11) of DLBCL have been treated in our institution with high-dose therapy (usually the BEAM protocol) and ASCT since 2008 (median age 61 years, range 28-73). Twenty-three patients received ASCT in a second treatment line, 25 in a third line (19 refractory to second-line salvage therapy, 5 after second relapse). Fifteen of these 48 patients received radiotherapy (36-50 Gy, median 40) of residual masses after ASCT. RESULTS Three-year overall survival (OS) and progression-free survival (PFS) after second-line ASCT were 61 and 57%, after third-line ASCT 47 and 44%, respectively, without significant differences. A prognostic factor was the International Prognostic Index (IPI) at the start of salvage therapy. Three-year OS and PFS in low-risk patients were 69 and 69%, in low-intermediate-risk 63 and 53%, and in high-intermediate-risk 23 and 23%, respectively (p = 0.033). Twenty-three patients achieved a sustained complete remission (13-146 months, median 62). CONCLUSION Sustained long-term remissions can be achieved in patients with early relapse of DLBCL following ASCT in a second or third treatment line, particularly in patients with low- and low-intermediate-risk IPI, following radiotherapy of residual disease after ASCT. Further investigations are required to clarify which patients need an alternative therapy (potentially CAR T‑cells or allogeneic transplantation).
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Affiliation(s)
- Bernd Metzner
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
| | - Jutta Welzel
- University Clinic for Radiotherapy and Radiooncology, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Thomas H Müller
- Red Cross Blood Transfusion Service NSTOB, Oldenburg, Germany
| | - Jochen Casper
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Christoph Kimmich
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | | | - Andrea Renzelmann
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Bernd Rosien
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Ruth Thole
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Andreas Voss
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Kay Willborn
- University Clinic for Radiotherapy and Radiooncology, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Claus Henning Köhne
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
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3
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Liu Y, Rao J, Li J, Wen Q, Wang S, Lou S, Yang T, Li B, Gao L, Zhang C, Kong P, Gao L, Wang M, Zhu L, Xiang X, Zhou S, Liu X, Peng X, Zhong J, Zhang X. Tandem autologous hematopoietic stem cell transplantation for treatment of adult T-cell lymphoblastic lymphoma: a multiple center prospective study in China. Haematologica 2021; 106:163-172. [PMID: 31780634 PMCID: PMC7776263 DOI: 10.3324/haematol.2019.226985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022] Open
Abstract
T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive form of lymphoma with poor clinical outcomes and no standard treatment regimen. In this study, we assessed the safety and efficacy of tandem autologous hematopoietic stem cell transplantation (auto-HSCT) for adult T-LBL and evaluated prognostic factors affecting survival. A total of 181 newly-diagnosed adult T-LBL patients were enrolled: 89 patients were treated with chemotherapy alone, 46 were allocated to the single auto-HSCT group, 46 were treated with tandem auto-HSCT. Median follow-up time was 37 months; the 3-year progression/relapse rate of the tandem auto- HSCT group was significantly lower than that of the single auto-HSCT and chemotherapy groups (26.5% vs. 53.1% and 54.8%). The 3-year progression- free survival (PFS) and overall survival (OS) rates of the tandem auto- HSCT group (73.5% and 76.3%) were significantly higher than those of the single auto-HSCT group (46.9% and 58.3%) and the chemotherapy group (45.1% and 57.1%). In the tandem auto-HSCT group, age and disease status after the first transplant impacted OS and PFS. Multivariate analysis identified that disease status after the first transplant was the only independent prognostic factor for patients treated with tandem-HSCT. In addition, diagnostic models of the initial CD8+CD28+/CD8+CD28– T-cell ratio in predicting the disease status were found to be significant. Taken together, tandem auto- HSCT can be considered an optimal strategy for adult T-LBL patients. (Study registered at: ChiCTR-ONN-16008480).
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Affiliation(s)
- Yao Liu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jun Rao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing
| | - Jiali Li
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Qin Wen
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sanbin Wang
- Dept. Hematology, General Hospital of Kunming Military Region of People Liberation Army, Kunming
| | - Shifeng Lou
- Department of Hematology, Second Affiliated Hospital of Chongqing Medical University,Chongqing,China
| | - Tonghua Yang
- Department of Hematology, Yunan Provincial People Hospital, Kunming, China
| | - Bin Li
- Department of Hematology, Second Yunnan Provincial People Hospital, Yunnan, China
| | - Lei Gao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Peiyan Kong
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing
| | - Li Gao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Maihong Wang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lidan Zhu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xixi Xiang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sha Zhou
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Liu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiangui Peng
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jiangfan Zhong
- Department of Pathology, University of Southern California, Keck School of Medicine
| | - Xi Zhang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
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4
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Gardenswartz A, Cairo MS. Hematopoietic Progenitor Cell Transplantation in Children, Adolescents, and Young Adults With Relapsed Mature B-Cell NHL. J Natl Compr Canc Netw 2020; 18:1135-1142. [PMID: 32755988 DOI: 10.6004/jnccn.2020.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Although children, adolescents, and young adults with newly diagnosed B-cell non-Hodgkin's lymphoma enjoy excellent overall survival with current chemoimmunotherapy, those with relapsed and/or refractory disease have a dismal prognosis. Although most clinicians would agree that hematopoietic progenitor cell transplantation after reinduction therapy is frontline therapy for these patients, there is no consensus as to what type of hematopoietic progenitor cell transplantation promises the best event-free and overall survival. This review outlines the disparate types of stem cell therapy that have been used in this difficult-to-treat population as well as the role of maintenance and CAR T-cell therapy in conjunction with stem cell therapy.
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Affiliation(s)
| | - Mitchell S Cairo
- Departments of Pediatrics.,Pathology.,Medicine.,Microbiology and Immunology, and.,Cell Biology and Anatomy, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York
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5
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Moleti ML, Testi AM, Foà R. Treatment of relapsed/refractory paediatric aggressive B-cell non-Hodgkin lymphoma. Br J Haematol 2020; 189:826-843. [PMID: 32141616 DOI: 10.1111/bjh.16461] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Aggressive B-cell non-Hodgkin lymphoma (B-NHL) accounts for ≈60% of NHL in children/adolescents. In newly diagnosed Burkitt lymphoma and diffuse large B-cell lymphoma, short intensive multiagent chemotherapy is associated with a five-year event-free survival of around 90%. Very few children/adolescents with aggressive B-NHL show a relapsed/refractory (r/r) disease. The outcome is poor, with cure rates <30%, and there is no standard of care. Rituximab-containing salvage regimens may provide a complete/partial response in 60-70% of cases. However, long-term survival is <10% for non-transplanted patients. Autologous or allogeneic haematopoietic stem cell transplant is, nowadays, the best option for responding patients, with survival rates around 50%. The benefit of autologous versus allogeneic HSCT is not clear. Numerous novel therapies for r/r B-NHL are currently being tested in adults, including next-generation monoclonal antibodies, novel cellular therapy strategies and therapies directed against new targets. Some are under investigation also in children/adolescents, with promising preliminary results.
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Affiliation(s)
- Maria L Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Anna M Testi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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6
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Sauer MG, Lang PJ, Albert MH, Bader P, Creutzig U, Eyrich M, Greil J, Gruhn B, Holter W, Klingebiel T, Kremens B, von der Leyen H, Mauz-Körholz C, Meisel R, Mischke K, Müller I, Niemeyer CM, Peters C, Pohler C, Reinhardt D, Burkhardt B, Schlegel PG, Schulz AS, Schrum J, Sedlacek P, Strahm B, Woessmann W, Handgretinger R, Zimmermann M, Borkhardt A. Hematopoietic stem cell transplantation for children with acute myeloid leukemia—results of the AML SCT-BFM 2007 trial. Leukemia 2019; 34:613-624. [DOI: 10.1038/s41375-019-0584-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 01/04/2023]
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7
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Chu Y, Gardenswartz A, Termuhlen AM, Cairo MS. Advances in cellular and humoral immunotherapy - implications for the treatment of poor risk childhood, adolescent, and young adult B-cell non-Hodgkin lymphoma. Br J Haematol 2019; 185:1055-1070. [PMID: 30613939 PMCID: PMC6555680 DOI: 10.1111/bjh.15753] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with relapsed, refractory or advanced stage B non-Hodgkin lymphoma (NHL) continue to have a dismal prognosis. This review summarises current and novel cellular and immunotherapy for these high-risk populations, including haematopoietic stem cell transplant, bispecific antibodies, viral-derived cytotoxic T cells, chimeric antigen receptor (CAR) T cells, and natural killer (NK) cell therapy, as discussed at the 6th International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma on September 26th-29th 2018 in Rotterdam, the Netherlands, and explores the future of NK/CAR NK therapies.
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Affiliation(s)
- Yaya Chu
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | | | - Amanda M. Termuhlen
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mitchell S. Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
- Department of Medicine, New York Medical College, Valhalla, NY, USA
- Department of Pathology, New York Medical College, Valhalla, NY, USA
- Department of Microbiology & Immunology, New York Medical College, Valhalla, NY, USA
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA
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8
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Gisselbrecht C, Van Den Neste E. How I manage patients with relapsed/refractory diffuse large B cell lymphoma. Br J Haematol 2018; 182:633-643. [PMID: 29808921 PMCID: PMC6175435 DOI: 10.1111/bjh.15412] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite progress in the upfront treatment of diffuse large B cell lymphoma (DLBCL), patients still experience relapses. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard second‐line treatment for relapsed and refractory (R/R) DLBCL. However, half of the patients will not be eligible for transplantation due to ineffective salvage treatment, and the other half will relapse after ASCT. In randomized studies, no salvage chemotherapy regimen is superior to another. The outcomes are affected by the secondary International Prognostic Index at relapse and various biological factors. The strategy is less clear in patients who require third‐line treatment. A multicohort retrospective non‐Hodgkin lymphoma research (SCHOLAR‐1) study conducted in 636 patients with refractory DLBCL showed an objective response rate of 26% (complete response 7%) to the next line of therapy with a median overall survival of 6·3 months. In the case of a response followed by transplantation, long‐term survival can be achieved in DLBCL patients. There is clearly a need for new drugs that improve salvage efficacy. Encouraging results have been reported with chimeric antigen receptor ‐T cell engineering, warranting further studies in a well‐defined control group of refractory patients. The Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) was used as a handy framework to build the discussion.
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9
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Long-term complete remission following tandem autologous stem cell transplantation and consolidative radiotherapy for refractory mediastinal gray-zone lymphoma. Int J Hematol 2018; 108:452-455. [PMID: 29786758 DOI: 10.1007/s12185-018-2471-x] [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] [Received: 02/12/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023]
Abstract
Mediastinal gray zone lymphoma (MGZL) is a provisional entity with intermediate features between classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma. Outcomes for patients with MGZL are reportedly poorer than those for patients with cHL or primary mediastinal large B-cell lymphoma. Additionally, no standard management guidelines for patients with MGZL are available, primarily due to its recent identification, rarity, and challenges in diagnosis. Although recent several studies have suggested dose-adjusted EPOCH-R (etoposide, doxorubicin, vincristine, cyclophosphamide, prednisolone, and rituximab) may improve outcomes in patients with MGZL, numerous patients still suffer from relapsed/refractory MGZL, and the optimal management for such patients remains uncertain. Here, we report the first case of successful treatment of refractory MGZL by tandem high-dose chemotherapy supported by autologous stem cell transplantations (auto-SCTs) and consolidative radiotherapy (RT). To date, the patient remains in CR 33 months after the completion of RT, with no significant complications. This case suggests that tandem auto-SCTs may be a promising therapeutic option for relapsed/refractory MGZL.
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10
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Gauthier J, Chantepie S, Bouabdallah K, Jost E, Nguyen S, Gac AC, Damaj G, Duléry R, Michallet M, Delage J, Lewalle P, Morschhauser F, Salles G, Yakoub-Agha I, Cornillon J. [Allogeneic haematopoietic cell transplantation for diffuse large B cell lymphoma: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S131-S135. [PMID: 29173980 DOI: 10.1016/j.bulcan.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022]
Abstract
Despite great improvements in the outcome of patients with lymphoma, some may still relapse or present with primary refractory disease. In these situations, allogeneic hematopoietic cell transplantation is a potentially curative option, this is true particularly in the case of after autologous stem cell transplantation if remission can be achieved. Recently, novel agents such as anti-PD1 and BTK inhibitors have started to challenge the use of allogeneic hematopoietic cell transplantation for relapsed or refractory lymphoma. During the 2016 annual workshop of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), we performed a comprehensive review of the literature published in the last 10 years and established guidelines to clarify the indications and transplant modalities in this setting. This section specifically reports on our conclusions regarding diffuse large B cell lymphoma.
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Affiliation(s)
- Jordan Gauthier
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Sylvain Chantepie
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Krimo Bouabdallah
- CHU Caen, service d'hématologie, Caen, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Edgar Jost
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Stéphanie Nguyen
- CHU Haut-Lévêque, service d'hématologie, Bordeaux, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Anne-Claire Gac
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gandhi Damaj
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Rémy Duléry
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Mauricette Michallet
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Jérémy Delage
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Montpellier, service d'hématologie, Montpellier, France
| | - Philippe Lewalle
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut Jules-Bordet, université Libre-de-Bruxelles, service d'hématologie, Bruxelles, Belgique
| | - Franck Morschhauser
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gilles Salles
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Ibrahim Yakoub-Agha
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Lille, LIRIC Inserm U995, université de Lille-2, 59000 Lille, France
| | - Jérôme Cornillon
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut de cancérologie Lucien-Neuwirth, département d'hématologie clinique, Saint-Priest-en-Jarez, France.
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11
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Palmer J, McCune JS, Perales MA, Marks D, Bubalo J, Mohty M, Wingard JR, Paci A, Hassan M, Bredeson C, Pidala J, Shah N, Shaughnessy P, Majhail N, Schriber J, Savani BN, Carpenter PA. Personalizing Busulfan-Based Conditioning: Considerations from the American Society for Blood and Marrow Transplantation Practice Guidelines Committee. Biol Blood Marrow Transplant 2016; 22:1915-1925. [PMID: 27481448 DOI: 10.1016/j.bbmt.2016.07.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
Abstract
The Practice Guidelines Committee of the American Society of Blood or Marrow Transplantation (ASBMT) sought to develop an evidence-based review about personalizing busulfan-based conditioning. The Committee sought to grade the relevant published studies (June 1, 2008 through March 31, 2016) according to criteria set forth by the Steering Committee for Evidence Based Reviews from ASBMT. Unfortunately, the published literature was too heterogeneous and lacked adequately powered and sufficiently controlled studies for this to be feasible. Despite this observation, the continued interest in this topic led the Practice Guidelines Committee to develop a list of most frequently asked questions (FAQs) regarding personalized busulfan dosing. This "Considerations" document is a list of these FAQs and their responses, addressing topics of practical relevance to hematopoietic cell transplantation clinicians.
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Affiliation(s)
- Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
| | - Jeannine S McCune
- Department of Pharmacology University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Miguel-Angel Perales
- Division of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Joseph Bubalo
- Department of Pharmacy Practice, Oregon Health Sciences University, Portland, Oregon
| | - Mohamad Mohty
- Department of Hematology, Hospital Saint-Antoine, University UPMC, Paris, France
| | - John R Wingard
- Division of Hematology/Oncology, University of Florida, Gainesville, Florida
| | - Angelo Paci
- Pharmacology and Drug Analysis Department, Institut de Cancerologie Gustav Roussy, Villejuif, France
| | - Moustapha Hassan
- Department of Clinical Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Bredeson
- Hematology, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Paul Shaughnessy
- Adult Blood and Marrow Transplant, Texas Transplant Physician's Group, San Antonio, Texas
| | - Navneet Majhail
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jeff Schriber
- Cancer Transplant Institute, Honor Health, Scottsdale, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbuilt-Ingram Cancer Center, Nashville, Tennessee
| | - Paul A Carpenter
- Department of Pediatrics, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
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12
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Flowers CR, Costa LJ, Pasquini MC, Le-Rademacher J, Lill M, Shore TB, Vaughan W, Craig M, Freytes CO, Shea TC, Horwitz ME, Fay JW, Mineishi S, Rondelli D, Mason J, Braunschweig I, Ai W, Yeh RF, Rodriguez TE, Flinn I, Comeau T, Yeager AM, Pulsipher MA, Bence-Bruckler I, Laneuville P, Bierman P, Chen AI, Kato K, Wang Y, Xu C, Smith AJ, Waller EK. Efficacy of Pharmacokinetics-Directed Busulfan, Cyclophosphamide, and Etoposide Conditioning and Autologous Stem Cell Transplantation for Lymphoma: Comparison of a Multicenter Phase II Study and CIBMTR Outcomes. Biol Blood Marrow Transplant 2016; 22:1197-1205. [PMID: 27040394 PMCID: PMC4914052 DOI: 10.1016/j.bbmt.2016.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/15/2016] [Indexed: 11/17/2022]
Abstract
Busulfan, cyclophosphamide, and etoposide (BuCyE) is a commonly used conditioning regimen for autologous stem cell transplantation (ASCT). This multicenter, phase II study examined the safety and efficacy of BuCyE with individually adjusted busulfan based on preconditioning pharmacokinetics. The study initially enrolled Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients ages 18 to 80 years but was amended due to high early treatment-related mortality (TRM) in patients > 65 years. BuCyE outcomes were compared with contemporaneous recipients of carmustine, etoposide, cytarabine, and melphalan (BEAM) from the Center for International Blood and Marrow Transplant Research. Two hundred seven subjects with HL (n = 66) or NHL (n = 141) were enrolled from 32 centers in North America, and 203 underwent ASCT. Day 100 TRM for all subjects (n = 203), patients > 65 years (n = 17), and patients ≤ 65 years (n = 186) were 4.5%, 23.5%, and 2.7%, respectively. The estimated rates of 2-year progression-free survival (PFS) were 33% for HL and 58%, 77%, and 43% for diffuse large B cell lymphoma (DLBCL; n = 63), mantle cell lymphoma (MCL; n = 29), and follicular lymphoma (FL; n = 23), respectively. The estimated rates of 2-year overall survival (OS) were 76% for HL and 65%, 89%, and 89% for DLBCL, MCL, and FL, respectively. In the matched analysis rates of 2-year TRM were 3.3% for BuCyE and 3.9% for BEAM, and there were no differences in outcomes for NHL. Patients with HL had lower rates of 2-year PFS with BuCyE, 33% (95% CI, 21% to 46%), than with BEAM, 59% (95% CI, 52% to 66%), with no differences in TRM or OS. BuCyE provided adequate disease control and safety in B cell NHL patients ≤ 65 years but produced worse PFS in HL patients when compared with BEAM.
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Affiliation(s)
- Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Division of BMT, Emory University, Atlanta, Georgia
| | - Luciano J Costa
- Medical University of South Carolina, Charleston, South Carolina
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Le-Rademacher
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Lill
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Tsiporah B Shore
- Weill Cornell Medical Center Hematology/Oncology, The New York Hospital, New York, New York
| | - William Vaughan
- Bone Marrow Transplantation Program, University of Alabaman at Birmingham, Birmingham, Alabama
| | - Michael Craig
- West Virginia University, Health Science Center, Morgantown, West Virginia
| | - Cesar O Freytes
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Mitchell E Horwitz
- Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Shin Mineishi
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Damiano Rondelli
- Department of Medicine, Section of Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Ira Braunschweig
- Department of Oncology, Montefiore Medical Center, Bronx, New York
| | - Weiyun Ai
- Medicine, University of California, San Francisco, San Francisco, California
| | - Rosa F Yeh
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tulio E Rodriguez
- Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, Tennessee
| | - Terrance Comeau
- New Brunswick Stem Cell Transplant Program, St. John, New Brunswick, Canada
| | - Andrew M Yeager
- Blood and Marrow Transplantation Program, The University of Arizona Cancer Center, Tucson, Arizona
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Children's Hospital Los Angeles, Keck School of Medicine and University of Southern California, Los Angeles, California
| | | | - Pierre Laneuville
- Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Philip Bierman
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Andy I Chen
- Center for Hematologic Malignancies, Oregon Health & Science University, Portland, Oregon
| | - Kazunobu Kato
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Yanlin Wang
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Cong Xu
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Angela J Smith
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Division of BMT, Emory University, Atlanta, Georgia.
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Ghosh N. Tandem Transplantations in Lymphoma--Best of Both Worlds. Biol Blood Marrow Transplant 2015; 21:1533-4. [PMID: 26169766 DOI: 10.1016/j.bbmt.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Nilanjan Ghosh
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
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