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Wang R, Shangguan X, Zhu Z, Cong D, Bai Y, Zhang W. BeEAM vs. BEAM: evaluating conditioning regimens for autologous stem cell transplantation in patients with relapsed or refractory DLBCL. Ann Hematol 2024; 103:2455-2462. [PMID: 38809456 DOI: 10.1007/s00277-024-05813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To evaluate whether BeEAM is an alternative to BEAM for autologous stem cell transplantation (ASCT) in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). METHODS Data of 60 patients with relapsed or refractory DLBCL who underwent ASCT from January 2018 to June 2023 in our center, including 30 patients in the BeEAM group and 30 patients in the BEAM group, were retrospectively analyzed. The time to hematopoietic reconstitution, treatment-related adverse events, number of hospitalization days, hospitalization cost, and survival benefit were compared between the two groups. RESULTS The clinical characteristics of the patients did not significantly differ between the two groups. The median number of reinfused CD34 + cells was 5.06 × 106/kg and 5.17 × 106/kg in the BeEAM and BEAM groups, respectively, which did not significantly different (p = 0.8829). In the BeEAM and BEAM groups, the median time to neutrophil implantation was 10.2 and 10.27 days, respectively (p = 0.8253), and the median time to platelet implantation was 13.23 and 12.87 days, respectively (p = 0.7671). In the BeEAM and BEAM groups, the median hospitalization duration was 30.37 and 30.57 days, respectively (p = 0.9060), and the median hospitalization cost was RMB 83,425 and RMB 96,235, respectively (p = 0.0560). The hospitalization cost was lower in the BeEAM group. The most common hematologic adverse events were grade ≥ 3 neutropenia and thrombocytopenia, whose incidences were similar in the two groups. The most common non-hematologic adverse events were ≤ grade 2 and the incidences of these events did not significantly differ between the two groups. Median overall survival was not reached in either group, with predicted 5-year overall survival of 72.5% and 60% in the BeEAM and BEAM groups, respectively (p = 0.5872). Five-year progression-free survival was 25% and 20% in the BeEAM and BEAM groups, respectively (p = 0.6804). CONCLUSION As a conditioning regimen for relapsed or refractory DLBCL, BeEAM has a desirable safety profile and is well tolerated, and its hematopoietic reconstitution time, number of hospitalization days, and survival benefit are not inferior to those of BEAM. BeEAM has a lower hospitalization cost and is an alternative to BEAM.
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Affiliation(s)
- Ruiqi Wang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Xinghe Shangguan
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116021, China
| | - Zhenxing Zhu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Dan Cong
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Yuansong Bai
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Wenlong Zhang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
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熊 艺, 陈 建, 刘 林, 罗 小, 唐 晓, 王 欣, 肖 青, 张 红, 王 利. [IEAC versus CEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation for lymphoma: analysis of efficacy and safety in 106 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1760-1767. [PMID: 33380399 PMCID: PMC7835682 DOI: 10.12122/j.issn.1673-4254.2020.12.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 11/24/2022]
Abstract
ObjectiveTo evaluate the efficacy and safety of IEAC (idarubici, etoposide, cytosine arabinoside, and cyclophosphamide) and CEAC (lomustine, etoposide, cytosine arabinoside, and cyclophosphamide) high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) in the treatment of lymphoma.MethodWe retrospectively analyzed the data of 106 lymphoma patients undergoing ASCT from 2013 to 2018 using IEAC (n=43) or CEAC (n=63) regimens. The time of hematopoietic reconstruction, adverse events and the patients' survival outcomes in the two groups were compared to evaluate the efficacy and safety of the two regimens. Univariate and multivariate analyses were performed to identify the factors potentially affecting the patients' survival.ResultsIn the total of 106 patients, successful hematopoietic reconstruction was achieved in 104 patients and treatment-related deaths occurred in 2 patients. No significant differences were observed in the time to hematopoietic recovery, adverse events or survival outcomes between the patients receiving IEAC and CEAC regimens. In the 104 patients with successful hematopoietic reconstruction who were followed for a median of 27.4 months (range 4.3 to 74.3 months), the 5-year progress-free survival (PFS) and overall survival (OS) rates were 72.9% and 81.9%, respectively. The main adverse events (beyond grade 2 based on CTCAE v5.0) included infection, oral mucositis, nausea and vomiting, liver damage, cardiotoxicity, hypokalemia, and diarrhea. No significant difference was found in the survival outcomes or adverse events between the 2 regimens. T cell lymphoma and failure to achieve complete remission (CR) before ASCT were the risk factors of PFS (P=0.015 and P=0.007, respectively) and OS (P=0.038 and 0.031, respectively). The patients who achieved CR 3 months after the transplantation had higher rates of PFS (P=0.007) and OS (P=0.003).ConclusionIEAC and CEAC regimens prior to by ASCT are both safe and effective in the treatment of lymphoma and can be used as alternative conditioning regimens for lymphoma patients undergoing ASCT.
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Affiliation(s)
- 艺颖 熊
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 建斌 陈
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 林 刘
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 小华 罗
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 晓琼 唐
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 欣 王
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 青 肖
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 红宾 张
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 利 王
- />重庆医科大学附属第一医院血液内科,重庆 400016Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Xie Y, Wang X, Leng X, Zheng W, Ping L, Zhang C, Liu W, Deng L, Wu M, Song Y, Zhu J. High-dose chemotherapy followed by autologous stem cell transplantation for patients with refractory/relapsed classical Hodgkin lymphoma: a single center experience from China. Ann Hematol 2020; 99:549-555. [PMID: 31980860 DOI: 10.1007/s00277-019-03812-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
To evaluate the outcomes of refractory/relapsed cHL patients after high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) in Beijing Cancer hospital and to identify the prognostic risk factors. We retrospectively analyzed 115 relapsed/refractory cHL patients who accepted HDCT and ASCT in our cancer center and had complete follow-up data from April 2000 to May 2017. Ages of these 115 patients at ASCT ranged from 14 to 63 (median age 28). Forty-four (38.3%) patients achieved CR and 50 (43.5%) patients achieved PR before ASCT. Thirty-seven (48.7%) patients of those 76 patients who did PET-CT before ASCT had negative PET-CT scans. The median follow-up time was 72 months. A total of 23 patients died in our study. The 5-year OS and PFS rates of all patients after ASCT were 78.7% and 53%, respectively. The 5-year OS rates after ASCT of patients who were in CR or PR or less than PR status before ASCT were 92.8%, 68.2%, and 76.2%, respectively (log-rank = 2.913, p = 0.233). And their 5-year PFS rates after ASCT were 69.2%, 54.2%, and 18.5%, respectively (log-rank = 13.615, p = 0.001). Univariate analysis revealed that ECOG (p = 0.010; hazard ratio = 1.578), disease status before ASCT (CR: p = 0.001; hazard ratio = 0.227) and after ASCT (CR: p < 0.001; hazard ratio = 0.154), and PET-CT results after ASCT (p = 0.023; hazard ratio = 0.438) significantly impact patients' PFS while number of pretransplant salvage chemotherapy (p = 0.037; hazard ratio = 2.521), radiotherapy (p = 0.046; hazard ratio = 0.423), and disease status after ASCT (CR: p = 0.010; hazard ratio = 0.197) significantly affected patients' OS. Multivariate analysis shown only disease status before ASCT (p = 0.002) had significant impact on PFS and disease status after ASCT (p = 0.021) had significant impact on OS. R/R HL patients can still obtain long-term PFS after HDCT and ASCT and disease status before ASCT was the most significant prognostic factor for PFS.
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Affiliation(s)
- Yan Xie
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaopei Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Leng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wen Zheng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingyan Ping
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chen Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiping Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijuan Deng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuqin Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ju Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Broccoli A, Zinzani PL. The role of transplantation in Hodgkin lymphoma. Br J Haematol 2018; 184:93-104. [DOI: 10.1111/bjh.15639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alessandro Broccoli
- Institute of Haematology; “L. e A. Seràgnoli”; University of Bologna; Bologna Italy
| | - Pier Luigi Zinzani
- Institute of Haematology; “L. e A. Seràgnoli”; University of Bologna; Bologna Italy
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Grisariu S, Shapira MY, Or R, Avni B. Thiotepa, Etoposide, Cyclophosphamide, Cytarabine, and Melphalan (TECAM) Conditioning Regimen for Autologous Stem Cell Transplantation in Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:272-279. [DOI: 10.1016/j.clml.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/16/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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Ozuah NW, Dahmoush HM, Grant FD, Lehmann LE, LaCasce AS, Billett AL, Margossian SP. Pretransplant functional imaging and outcome in pediatric patients with relapsed/refractory Hodgkin lymphoma undergoing autologous transplantation. Pediatr Blood Cancer 2018; 65. [PMID: 28696028 DOI: 10.1002/pbc.26707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pretransplant functional imaging (FI), particularly a negative positron emission tomography (PET), is a strong predictor of outcome in adults with relapsed or refractory Hodgkin lymphoma (HL), but data in pediatrics are limited. METHODS The medical records of 49 consecutive pediatric patients, who received autologous transplant at a single institution, were retrospectively analyzed. All patients had either gallium or PET scan before transplant and were conditioned with carmustine, etoposide, cytarabine, and melphalan (BEAM). Deauville scores were retrospectively assigned for patients with PET (score ≥ 4 positive). RESULTS Of the 49 patients (median age, 16.2 years), 41 (84%) were pretransplant FI negative and eight (16%) were pretransplant FI positive, after first- to fourth-line salvage therapy, and a median of two salvage cycles. Eighteen patients (37%) received posttransplant radiation. At a median follow up of 46 months, 45 patients (92%) were alive and disease free, and there were three nonrelapse deaths and only one relapse death (Deauville score of 5). The 4-year progression-free survival (PFS) for the entire cohort was 92% (95% confidence interval [CI]: 78-97), and PFS based on pretransplant disease status was 95% (95% CI: 82-99%) in the negative FI group versus 75% (95% CI: 31-93) if positive FI (P = 0.057). CONCLUSION Our analysis revealed outstanding outcomes for children and adolescents with relapsed/refractory HL. There were too few relapses to identify the predictive value of pretransplant metabolic status, but pediatric patients with relapsed/refractory HL and a negative pretransplant FI had excellent survival.
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Affiliation(s)
- Nmazuo W Ozuah
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Hisham M Dahmoush
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Frederick D Grant
- Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie E Lehmann
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy L Billett
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Steven P Margossian
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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Shi Y, Liu P, Zhou S, Yang J, Han X, He X, Zhang C, Gui L, Qin Y, Yang S, Zhao L, Yao J, Jia B, Zhang S, Sun Y, Shi Y. Comparison of CBV, BEAM and BEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation in non-Hodgkin lymphoma: Efficacy and toxicity. Asia Pac J Clin Oncol 2017; 13:e423-e429. [PMID: 28101911 DOI: 10.1111/ajco.12610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Youwu Shi
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Peng Liu
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Shengyu Zhou
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jianliang Yang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiaohong Han
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiaohui He
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Changgong Zhang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Lin Gui
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan Qin
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Sheng Yang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Liya Zhao
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jiarui Yao
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Bo Jia
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Shuxiang Zhang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan Sun
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yuankai Shi
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
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It's Personal: Achieving Optimal Busulfan Exposure for All Patients. Biol Blood Marrow Transplant 2016; 22:1149-1150. [DOI: 10.1016/j.bbmt.2016.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/22/2022]
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9
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Musso M, Messina G, Di Renzo N, Di Carlo P, Vitolo U, Scalone R, Marcacci G, Scalzulli PR, Moscato T, Matera R, Crescimanno A, Santarone S, Orciuolo E, Merenda A, Pavone V, Pastore D, Donnarumma D, Carella AM, Ciochetto C, Cascavilla N, Mele A, Lanza F, Di Nicola M, Bonizzoni E, Pinto A. Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen. Br J Haematol 2016; 172:111-21. [PMID: 26458240 PMCID: PMC5053328 DOI: 10.1111/bjh.13803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/03/2015] [Indexed: 01/04/2023]
Abstract
High-dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third-generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR-HL accrued into a prospective registry-based study. Application of FEAM resulted in a 2-year progression-free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64-0·81] with median PFS, overall survival and time to progression yet to be reached. The 2-year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12-0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose ((18) (F) FDG)-uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had (18) (F) FDG-positrin emission tomography-positive lesions before HDT, the 2-year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12-0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR-HL patients typically pre-exposed to lung-damaging treatments.
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Affiliation(s)
- Maurizio Musso
- Dipartimento Oncologico “La Maddalena”UOC di Oncoematologia e TMOPalermoItaly
| | - Giuseppe Messina
- Azienda Ospedaliera ‘Bianchi Melacrino Morelli’C.T.M.O. Centro Unico Regionale Trapianti di Cellule Staminali e Terapie CellulariReggio CalabriaItaly
| | - Nicola Di Renzo
- UOC di Ematologia e Trapianto di Cellule StaminaliP.O. “Vito Fazzi”LecceItaly
| | - Paolo Di Carlo
- Unità Terapia Intensiva Ematologica per il Trapianto EmopoieticoOspedale CivilePescaraItaly
| | - Umberto Vitolo
- Dipartimento di Oncologia ed EmatologiaA.O. U.Città della Salute e della Scienza di Torino San Giovanni BattistaS.C. EmatologiaTorinoItaly
| | - Renato Scalone
- Dipartimento Oncologico “La Maddalena”UOC di Oncoematologia e TMOPalermoItaly
| | - Gianpaolo Marcacci
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
| | - Potito R. Scalzulli
- Divisione di EmatologiaIRCSS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
| | - Tiziana Moscato
- Azienda Ospedaliera ‘Bianchi Melacrino Morelli’C.T.M.O. Centro Unico Regionale Trapianti di Cellule Staminali e Terapie CellulariReggio CalabriaItaly
| | - Rossella Matera
- UOC di Ematologia e Trapianto di Cellule StaminaliP.O. “Vito Fazzi”LecceItaly
| | | | - Stella Santarone
- Unità Terapia Intensiva Ematologica per il Trapianto EmopoieticoOspedale CivilePescaraItaly
| | - Enrico Orciuolo
- Dipartimento di Oncologia, Trapianti e Tecnologie AvanzateAzienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Anxur Merenda
- ARNAS Ospedale Civico BenfratelliU.O. di EmatologiaPalermoItaly
| | - Vincenzo Pavone
- Ospedale Generale Provinciale “Cardinale G. Panico”S.C. di Ematologia e Trapianto di Cellule StaminaliTricase, LecceItaly
| | | | - Daniela Donnarumma
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
| | - Angelo M. Carella
- U.O. Complessa di EmatologiaIRCCS Azienda Ospedaliera Universitaria San Martino‐ISTGenovaItaly
| | - Chiara Ciochetto
- Dipartimento di Oncologia ed EmatologiaA.O. U.Città della Salute e della Scienza di Torino San Giovanni BattistaS.C. EmatologiaTorinoItaly
| | - Nicola Cascavilla
- Divisione di EmatologiaIRCSS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
| | - Anna Mele
- Ospedale Generale Provinciale “Cardinale G. Panico”S.C. di Ematologia e Trapianto di Cellule StaminaliTricase, LecceItaly
| | - Francesco Lanza
- Unità Operativa di EmatologiaIstituti Ospitalieri di CremonaCremonaItaly
| | - Massimo Di Nicola
- Dipartimento di Oncologia MedicaFondazione IRCCS Istituto Nazionale TumoriMilanoItaly
| | - Erminio Bonizzoni
- Sezione di Statistica Medica e Biometria ‘GA Maccaro’Dipartimento di Scienze Cliniche e di ComunitàUniversità di MilanoMilanoItaly
| | - Antonello Pinto
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
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Comparison of 2 Carmustine-Containing Regimens in the Rituximab Era: Excellent Outcomes Even in Poor-Risk Patients. Biol Blood Marrow Transplant 2015; 21:1926-31. [DOI: 10.1016/j.bbmt.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/04/2015] [Indexed: 11/20/2022]
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A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma. Bone Marrow Transplant 2015; 50:1416-23. [PMID: 26237164 PMCID: PMC4633349 DOI: 10.1038/bmt.2015.177] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 12/18/2022]
Abstract
Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pre-transplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995–2010. The probabilities of progression free survival (PFS) at 1, 5 and 10 years were 66% (95% CI: 62–70), 52% (95% CI: 48–57) and 47% (95% CI: 42–51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ≥90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low, intermediate and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64–80), 53% (95% CI: 47–59) and 23% (95% CI: 9–36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk for progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.
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12
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Lahoud OB, Sauter CS, Hamlin PA, Dahi PB. High-Dose Chemotherapy and Autologous Stem Cell Transplant in Older Patients with Lymphoma. Curr Oncol Rep 2015. [PMID: 26201264 DOI: 10.1007/s11912-015-0465-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplant (HDT/ASCT) can improve survival in patients with lymphoma. Limited experience is available on the safety and efficacy of HDT/ASCT in elderly patients. In this article, we review the published data on the role of HDT/ASCT in management of lymphoma in older patients. Based on available data, evaluation of comorbidities, functional status, and comprehensive geriatric assessment (CGA) will help identify those who can benefit most from this intervention. Prospective clinical trials focusing on HDT/ASCT in older patients with lymphoma are needed to establish optimal management protocols in this select population.
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Affiliation(s)
- Oscar B Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bhatt VR, Loberiza FR, Jing H, Bociek RG, Bierman PJ, Maness LJ, Vose JM, Armitage JO, Akhtari M. Mortality Patterns Among Recipients of Autologous Hematopoietic Stem Cell Transplantation for Lymphoma and Myeloma in the Past Three Decades. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:409-415.e1. [DOI: 10.1016/j.clml.2015.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/13/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
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14
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Bachanova V, Shanley R, Malik F, Chauhan L, Lamba V, Weisdorf DJ, Burns LJ, Lamba JK. Cytochrome P450 2B6*5 Increases Relapse after Cyclophosphamide-Containing Conditioning and Autologous Transplantation for Lymphoma. Biol Blood Marrow Transplant 2015; 21:944-8. [PMID: 25677220 PMCID: PMC4772424 DOI: 10.1016/j.bbmt.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/03/2015] [Indexed: 01/11/2023]
Abstract
Cyclophosphamide (Cy) is a prodrug that depends on bioactivation by hepatic cytochrome P450 (CYP) enzymes for its cytotoxicity. We evaluated the influence of single nucleotide polymorphisms (SNPs) of CYP enzymes on the efficacy of autologous hematopoietic cell transplantation (HCT) for lymphoma. SNPs of 22 genes were analyzed in 93 patients with Hodgkin (n = 52) and non-Hodgkin lymphoma (n = 41) treated with high-dose Cy followed by autologous HCT between 2004 and 2012. Preparative regimens contained Cy (120 mg/kg) combined with carmustine/etoposide (n = 61) or Cy (6000 mg/m(2)) with total body irradiation (n = 32). Lack of complete remission as measured by pretransplant positron emission tomography was the sole clinical factor associated with increased risk of relapse (HR, 2.1). In genomic analysis, we identified a single SNP (rs3211371) in exon 9 (C > T) of the CYP2B6 gene (allele designation 2B6*5) that significantly impacted patient outcomes. After adjusting for disease status and conditioning regimen, patients with the CYP2B6*1/*5 genotype had a higher 2-year relapse rate (HR, 3.3; 95% CI, 1.6 to 6.5; P = .041) and decreased overall survival (HR, 13.5; 95% CI, 3.5 to 51.9; P = .008) than patients with the wild-type allele. Two-year progression-free survival for patients with 2 hypofunctional CYP2B6 variant genotypes (*5 and *6) was only 11% (95% CI, 1% to 39%) compared with 67% (95% CI, 55% to 77%) for patients with the wild-type CYP2B6*1 allele in exon 9. Our results suggest that CYP2B6 SNPs influence the efficacy of high-dose Cy and significantly reduce the success of autologous HCT for lymphoma patients with the CYP2B6*5 variant.
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Affiliation(s)
- Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | - Ryan Shanley
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Farhana Malik
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Lata Chauhan
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Vishal Lamba
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Linda J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Jatinder Kaur Lamba
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
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15
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Chen YB, Lane AA, Logan B, Zhu X, Akpek G, Aljurf M, Artz A, Bredeson CN, Cooke KR, Ho VT, Lazarus HM, Olsson R, Saber W, McCarthy P, Pasquini MC. Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015; 21:1046-1053. [PMID: 25687795 DOI: 10.1016/j.bbmt.2015.02.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
Abstract
There are limited data to guide the choice of high-dose therapy (HDT) regimen before autologous hematopoietic cell transplantation (AHCT) for patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). We studied 4917 patients (NHL, n = 3905; HL, n = 1012) who underwent AHCT from 1995 to 2008 using the most common HDT platforms: carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) (n = 1730); cyclophosphamide, BCNU, and etoposide (CBV) (n = 1853); busulfan and cyclophosphamide (BuCy) (n = 789); and total body irradiation (TBI)-containing treatment (n = 545). CBV was divided into CBV(high) and CBV(low) based on BCNU dose. We analyzed the impact of regimen on development of idiopathic pulmonary syndrome (IPS), transplantation-related mortality (TRM), and progression-free and overall survival. The 1-year incidence of IPS was 3% to 6% and was highest in recipients of CBV(high) (hazard ratio [HR], 1.9) and TBI (HR, 2.0) compared with BEAM. One-year TRM was 4% to 8%, respectively, and was similar between regimens. Among patients with NHL, there was a significant interaction between histology, HDT regimen, and outcome. Compared with BEAM, CBV(low) (HR, .63) was associated with lower mortality in follicular lymphoma (P < .001), and CBV(high) (HR, 1.44) was associated with higher mortality in diffuse large B cell lymphoma (P = .001). For patients with HL, CBV(high) (HR, 1.54), CBV(low) (HR, 1.53), BuCy (HR, 1.77), and TBI (HR, 3.39) were associated with higher mortality compared with BEAM (P < .001). The impact of specific AHCT regimen on post-transplantation survival is different depending on histology; therefore, further studies are required to define the best regimen for specific diseases.
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Affiliation(s)
- Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospita1, Boston, MA
| | - Andrew A Lane
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Brent Logan
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Xiaochun Zhu
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Görgün Akpek
- Department of Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Andrew Artz
- Section of Hematology/Oncology, University of Chicago Hospitals, Chicago, IL
| | - Christopher N Bredeson
- Department of Medicine, The Ottawa Hospital Blood & Marrow Transplant Program, Ottawa, Ontario, Canada
| | - Kenneth R Cooke
- Division of Pediatric Oncology, Bone Marrow Transplant Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD
| | - Vincent T Ho
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Hillard M Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Richard Olsson
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Wael Saber
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Philip McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Marcelo C Pasquini
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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16
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Garfin PM, Link MP, Donaldson SS, Advani RH, Luna-Fineman S, Kharbanda S, Porteus M, Weinberg KI, Agarwal-Hashmi R. Improved Outcomes after Autologous Bone Marrow Transplantation for Children with Relapsed or Refractory Hodgkin Lymphoma: Twenty Years Experience at a Single Institution. Biol Blood Marrow Transplant 2015; 21:326-34. [DOI: 10.1016/j.bbmt.2014.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/22/2014] [Indexed: 01/10/2023]
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17
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18
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Kosuri S, van Besien K. Great expectations? Conditioning with busulfan, melphalan and thiotepa in recurrent Hodgkin lymphoma. Leuk Lymphoma 2014; 55:476-7. [PMID: 24471910 DOI: 10.3109/10428194.2014.887715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Satyajit Kosuri
- Medicine, Weill Cornell Medical College , New York, NY , USA
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