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Berning P, Fekom M, Ngoya M, Goldstone AH, Dreger P, Montoto S, Finel H, Shumilov E, Chevallier P, Blaise D, Strüssmann T, Carpenter B, Forcade E, Castilla-Llorente C, Trneny M, Ghesquieres H, Capria S, Thieblemont C, Blau IW, Meijer E, Broers AEC, Huynh A, Caillot D, Rösler W, Nguyen Quoc S, Bittenbring J, Nagler A, Galimard JE, Glass B, Sureda A, Schmitz N. Hematopoietic stem cell transplantation for DLBCL: a report from the European Society for Blood and Marrow Transplantation on more than 40,000 patients over 32 years. Blood Cancer J 2024; 14:106. [PMID: 38969655 PMCID: PMC11226679 DOI: 10.1038/s41408-024-01085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Autologous(auto-) and allogeneic(allo-) hematopoietic stem cell transplantation (HSCT) are key treatments for relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their roles are challenged by CAR-T-cells and other immunotherapies. We examined the transplantation trends and outcomes for DLBCL patients undergoing auto-/allo-HSCT between 1990 and 2021 reported to EBMT. Over this period, 41,148 patients underwent auto-HSCT, peaking at 1911 cases in 2016, while allo-HSCT saw a maximum of 294 cases in 2018. The recent decline in transplants corresponds to increased CAR-T treatments (1117 cases in 2021). Median age for auto-HSCT rose from 42 (1990-1994) to 58 years (2015-2021), with peripheral blood becoming the primary stem cell source post-1994. Allo-HSCT median age increased from 36 (1990-1994) to 54 (2015-2021) years, with mobilized blood as the primary source post-1998 and reduced intensity conditioning post-2000. Unrelated and mismatched allo-HSCT accounted for 50% and 19% of allo-HSCT in 2015-2021. Three-year overall survival (OS) after auto-HSCT improved from 56% (1990-1994) to 70% (2015-2021), p < 0.001, with a decrease in relapse incidence (RI) from 49% to 38%, while non-relapse mortality (NRM) remained unchanged (4%). After allo-HSCT, 3-year-OS increased from 33% (1990-1999) to 46% (2015-2021) (p < 0.001); 3-year RI remained at 39% and 1-year-NRM decreased to 19% (p < 0.001). Our data reflect advancements over 32 years and >40,000 transplants, providing insights for evaluating emerging DLBCL therapies.
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Affiliation(s)
- Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Mathilde Fekom
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Maud Ngoya
- European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Silvia Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation, Paris, France
| | - Evgenii Shumilov
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Didier Blaise
- Transplantation and Cellular Immunotherapy Program, Department of Hematology, Instititut Paoli Calmettes, MSC Lab, Aix Marseille University, Marseille, France
| | - Tim Strüssmann
- Department of Hematology, Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, Freiburg, Germany
| | - Ben Carpenter
- Department of Hematology, University College London Hospitals, London, United Kingdom
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | | | - Marek Trneny
- First Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Hervé Ghesquieres
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | - Saveria Capria
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Igor Wolfgang Blau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Berlin, Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Clinic, Berlin, Germany
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | | | - Wolf Rösler
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Nguyen Quoc
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Jörg Bittenbring
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Bertram Glass
- Department of Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anna Sureda
- Department of Hematology, Institut Català d'Oncologia Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Norbert Schmitz
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
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Lin Y, Park Y, Khanal A, Campbell-Lee S, Liu L, Chen Z, Patel P, Vidanovic V, Sweiss K, Irene G, Peace D, Rondelli D, Mahmud N. A Comparison of Four Leukapheresis Methods to Harvest an Optimal Dose of CD34+ Cells: A Single Center Experience. Eur J Haematol 2022; 109:711-718. [PMID: 36030395 DOI: 10.1111/ejh.13856] [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: 03/18/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chemokine receptor CXCR4 antagonist plerixafor (Px) as well as high volume (HV) leukapheresis have been shown to reduce hematopoietic stem progenitor cell (HSPC) mobilization failure rates. However, no direct comparisons of such methods currently exists. METHODS AND MATERIALS We compared the HSPC collection yield based on basal peripheral blood CD34+ cell numbers in patients diagnosed with multiple myeloma or non-Hodgkin's lymphoma undergoing autologous stem cell transplantation in a retrospective chart review. The leukapheresis methods used included HV vs. regular volume (RV) with or without Px. There were 116 patients in the study group while the historical control group had 34 patients. RESULTS AND CONCLUSIONS Control group underwent RV leukapheresis without Px. Addition of Px or HV in the study group failed to display significant improvement in CD34+ cell collection yield; however, when basal CD34+ cell numbers were taken into account, both Px+RV and HV without Px increased CD34+ cell collection yield. The collection failure rates of HV without Px group were comparable to Px+RV when the basal CD34+ cell numbers were over 20/μL. Of interest, multivariate linear regression analysis did not detect any significant difference between HV vs Px+RV or other leukapheresis methods in CD34 yields or collection failure rates from a single collection after controlling for other factors (sex, age or underlying disease). In multivariate analysis, pre apheresis CD34+ cell number was significantly and positively associated with the CD34+ cell yields from a single apheresis. In our studies, the majority of patients can be rescued without Px by HV alone as a potential cost saving approach. In summary, trend in our studies reflects that both Px and HV are capable of reducing the mobilization failure rates except the poorest mobilizers which will need to be validated in larger studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuankai Lin
- Division of Hematology and Oncology, University of Illinois College of Medicine
| | | | - Amit Khanal
- Division of Hematology and Oncology, University of Illinois College of Medicine
| | | | - Li Liu
- Division of Epidemiology and Biostatistics.,Biostatistics Shared Resource of University of Illinois Cancer Center
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics.,Biostatistics Shared Resource of University of Illinois Cancer Center
| | - Pritesh Patel
- Division of Hematology and Oncology, University of Illinois College of Medicine
| | | | - Karen Sweiss
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago
| | | | - David Peace
- Division of Hematology and Oncology, University of Illinois College of Medicine
| | - Damiano Rondelli
- Division of Hematology and Oncology, University of Illinois College of Medicine
| | - Nadim Mahmud
- Division of Hematology and Oncology, University of Illinois College of Medicine.,Clinical Stem Cell Laboratory, UI Health
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Sapelli J, Filho JS, Matias Vieira GM, Moura FL, Germano JN, de Lima VCC. BuCyE can safely replace BEAM as a conditioning regimen for autologous stem cell transplantation in the treatment of refractory and relapsed lymphomas. Leuk Res 2021; 110:106689. [PMID: 34592699 DOI: 10.1016/j.leukres.2021.106689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Hodgkin's (HL) and non-Hodgkin's (NHL) lymphomas have usually high cure rates. The standard of care for chemosensitive relapsed/refractory lymphoma patients is salvage chemotherapy followed by AHSCT. Due to carmustine and melphalan shortages, alternative pre-AHSCT conditioning regimens with similar tolerance and response were needed. OBJECTIVES To compare the efficacy and toxicity profile between relapsed/refractory HL and NHL lymphomas given BEAM or BuCyE. METHODS A retrospective analyses of 122 patients in a Brazilian center was made. OS and PFS were calculated by Kaplan-Meier and compared by log rank. Toxicity and engraftment data were also compared. RESULTS Most clinical characteristics were similar between groups, although a higher frequency of grade ≥ 2 mucositis (p = .01) was seen in the BuCyE group. No significant difference in OS or PFS were observed between the groups. CONCLUSION BEAM and BuCyE are well tolerated with similar toxicity profiles and survival outcomes. Therefore, BuCyE conditioning regimen can be considered an alternative to BEAM.
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Affiliation(s)
- Jaqueline Sapelli
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Jayr Schmidt Filho
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Fernanda Lemos Moura
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil
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A risk model for relapsed/refractory aggressive NHL integrating clinical risk factors and pretransplant Deauville score. Blood Adv 2021; 4:5762-5771. [PMID: 33216888 DOI: 10.1182/bloodadvances.2020002814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022] Open
Abstract
There are limited data regarding the combined value of the pretransplant Deauville score (DS) from a positron emission tomography scan and clinical risk factors in patients with relapsed/refractory aggressive non-Hodgkin lymphoma (NHL). We performed a retrospective analysis to assess the prognostic role of pretransplant DS in patients with relapsed/refractory aggressive NHL who underwent salvage chemotherapy and autologous stem cell transplantation (ASCT). We identified 174 eligible patients between January 2013 and March 2019. In multivariable analysis, pretransplant DS, B symptoms, and secondary International Prognostic Index (sIPI) were independent risk factors for event-free survival (EFS). These variables were used to derive an integrated risk score that categorized 166 patients with available information for all risk factors into 3 groups: low (n = 92; 55.4%), intermediate (n = 48; 28.9%), and high (n = 26; 15.7%). The new prognostic index showed a strong association with EFS (low-risk vs intermediate-risk hazard ratio [HR], 3.94; 95% confidence interval [CI], 2.16-7.17; P < .001; low-risk vs high-risk HR, 10.83; 95% CI, 5.81-20.19; P < .001) and outperformed models based on clinical risk factors or DS alone. These results were validated in 60 patients from an independent external cohort (low-risk vs intermediate-risk HR, 4.04; 95% CI, 1.51-10.82; P = .005; low-risk vs high-risk HR, 10.49; 95% CI, 4.11-26.73; P < .001). We propose and validate a new prognostic index that risk-stratifies patients undergoing salvage chemotherapy followed by ASCT, thereby identifying patients at high risk for posttransplant treatment failure.
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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6
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Gaut D, Romero T, Oveisi D, Howell G, Schiller G. Disease characteristics of diffuse large B-cell lymphoma predicting relapse and survival after autologous stem cell transplantation: A single institution experience. Hematol Oncol 2019; 38:38-50. [PMID: 31674036 DOI: 10.1002/hon.2690] [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: 08/13/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/08/2022]
Abstract
While various tools such as the International Prognostic Index (IPI) and its derivatives exist for risk-stratification of diffuse large B-cell lymphoma (DLBCL) at diagnosis, patient and disease characteristics capable of predicting outcome after high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) are not clearly defined. We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed and 33 refractory) who underwent HDC/ASCT at our institution from 2010-2015. After a median follow-up time of 4.6 years (interquartile range [IQR] 2.2-8.1), the likelihood of 5-year progression-free survival (PFS) was 62.2% (95% CI, 53.4%-72.4%) and the likelihood of 5-year overall survival (OS) was 68.9% (95% CI, 60.7%-78.2%). More than three chemotherapy regimens prior to ASCT was the only variable associated with lower likelihood of PFS (P = .004) and OS (P = 0.026). Male gender and high IPI score at time of ASCT were also associated with lower likelihood of PFS (P = .043; P = .013). NCCN IPI and age-adjusted IPI at time of ASCT were not predictive of outcome following ASCT. Patients with refractory and relapsed disease had similar outcomes post-ASCT (P = .207 for PFS, P = .073 for OS).
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Affiliation(s)
- Daria Gaut
- Deparment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David Oveisi
- Deparment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Grant Howell
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gary Schiller
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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7
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Kallam A, Vose JM. Recent Advances in CAR-T Cell Therapy for Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:751-757. [PMID: 31648957 DOI: 10.1016/j.clml.2019.09.598] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
Adoptive cellular immunotherapy with anti CD19 chimeric antigen receptor (CAR)-T cell has changed the treatment landscape in relapsed/refractory B cell lymphomas. They have emerged as effective therapy in patients with multiple relapsed/refractory disease, capable of sustaining durable remissions. Two CAR-T cell products (axicabtagene ciloleucel and tisagenlecleucel) are currently approved by the United States Food and Drug Administration. A third anti CD19 CAR-T cell, lisocabtagene ciloleucel is currently being evaluated in large clinical trials and may also be United States Food and Drug Administration-approved soon. CAR-T cell-related toxicities, including infections, cytokine release syndrome, and neurotoxicity are potential complications of therapy. With increasing use of CAR-T cells, the mechanism of toxicities and mitigation strategies needs to be developed. Additionally, reasons for CAR-T cell failure and progression following this therapy needs to be further studied. We describe the recent developments in this field, with emphasis on the complications of therapy and factors contributing to toxicities, efficacy, and resistance. We also describe the ongoing research in this field and the newer CAR-T cell constructs that are being developed to counter the challenges that have been identified in this field.
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Affiliation(s)
- Avyakta Kallam
- Division of Hematology/Oncology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE.
| | - Julie M Vose
- Division of Hematology/Oncology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE
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8
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Plerixafor for patients who fail cytokine-or chemotherapy-based stem cell mobilization: Results of a prospective study by the Polish Lymphoma Research Group (PLRG). ACTA ACUST UNITED AC 2018. [DOI: 10.2478/ahp-2018-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractAutologous hematopoietic stem cell transplantation (autoHSCT) requires collection of sufficient number of hematopoietic stem cells. The goal of this study was to evaluate efficacy of plerixafor used in patients with lymphoid malignancies failing conventional stem cell mobilization.This was a prospective, non-interventional study. All consecutive patients (n = 109) treated with plerixafor in 11 centers were reported. The drug was used either in case of previous mobilization failure (n = 67) or interventionally, in case of insufficient CD34+ cell output during current mobilization (n = 42). Successful mobilization was defined as resulting in collection of ≥ 2 × 106 CD34+ cells/kg for single autoHSCT or ≥ 4 × 106 CD34+ cells/kg for double procedure.The overall rate of successful mobilization was 55% (55% for single and 56% for double autoHSCT). The median total number of collected CD34+ cells/kg was 2.4 (range, 0-11.5) for patients intended for a single transplantation while 4.0 (0.6-16.9) for double procedure. The number of circulating CD34+ cells increased after the use of plerixafor regardless of baseline values. The median fold increase was 3.3 (0.3-155). Data from this observational study confirm high efficacy of plerixafor used in routine clinical practice as salvage for patients with lymphoid malignancies failing conventional stem cell mobilization.
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9
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Moore DC, Arnall JR, Plesca DC. Transitioning historically inpatient chemotherapy regimens for hematologic malignancies to the ambulatory care setting. Am J Health Syst Pharm 2018; 75:1824-1830. [PMID: 30131323 DOI: 10.2146/ajhp180060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Justin R Arnall
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Dragos C Plesca
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
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Soudy H, Maghfoor I, Elhassan TAM, Abdullah E, Rauf SM, Al Zahrani A, Akhtar S. Translation and validation of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) version 4 quality of life instrument into Arabic language. Health Qual Life Outcomes 2018. [PMID: 29530033 PMCID: PMC5848601 DOI: 10.1186/s12955-018-0861-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) has been translated from English into several languages. Currently, there is no validated translation of FACT-BMT in Arabic. Here, we are reporting the first Arabic translation and validation of the FACT-BMT. Methods The study was approved by the Institutional Research Advisory Council. The Arabic translation followed the standard Functional Assessment of Chronic Illness Therapy (FACIT.org) translation methodology (with permission). Arabic FACT-BMT (50- items) was statistically validated. Cronbach’s alpha for internal consistency, Spearman’s rank correlation coefficients method for Inter-scale correlations and Principal Component Analysis for factorial construct validity was used. Results One hundred and eight consecutive relapsed /refractory lymphoma patients who underwent high dose chemotherapy and autologous stem cell transplant were enrolled. There were 68 males (63%) and 40 females (37%) with a median age of 29 years (range 14–62). After Arabic questionnaire pre-testing (Cronbach’s alpha 0.744), the study included 108 patients. Cronbach’s alpha for the entire FACT-BMT indicated an excellent internal consistency (0.90); range (0.67 to 0.91). Cronbach’s alpha for sub-groups of social (0.78), emotional (0.67) and functional wellbeing was (0.88). Cronbach’s alpha for bone marrow transplant (0.81), FACT-General (0.89), and FACT- Trial Outcome Index (TOI); (0.91) also revealed excellent internal consistency. Patients had high scores in all domains of quality of life, indicating that most patients were leading a normal life. This translation of FACT-BMT in Arabic was reviewed and approved for submission by the FACIT.org. Conclusions Our data reports the first translated, validated and approved Arabic version of FACT-BMT. This will help large numbers of Arabic speaking patients undergoing stem cell/bone marrow transplantation, across the globe. Electronic supplementary material The online version of this article (10.1186/s12955-018-0861-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hussein Soudy
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Irfan Maghfoor
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Tusneem Ahmed M Elhassan
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Eman Abdullah
- Department of Nursing Affairs, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Shahzad M Rauf
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Ahmed Al Zahrani
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Saad Akhtar
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia.
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11
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Vardhana SA, Sauter CS, Matasar MJ, Zelenetz AD, Galasso N, Woo KM, Zhang Z, Moskowitz CH. Outcomes of primary refractory diffuse large B-cell lymphoma (DLBCL) treated with salvage chemotherapy and intention to transplant in the rituximab era. Br J Haematol 2017; 176:591-599. [PMID: 27982423 PMCID: PMC5556376 DOI: 10.1111/bjh.14453] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/12/2016] [Indexed: 12/15/2022]
Abstract
Rituximab-containing salvage chemotherapy followed by high-dose therapy and autologous stem cell transplant (ASCT) in chemosensitive patients remains the standard of care for patients with relapsed and refractory diffuse large B-cell lymphoma (DLBCL). However, its role in those patients achieving less than a complete response to first-line therapy (primary refractory disease) in the rituximab era is not well defined. We reviewed the outcomes of 82 transplant-eligible patients with primary refractory DLBCL who underwent salvage therapy with the intent of administering high-dose therapy and ASCT to patients achieving chemosensitive remission. The estimated 3-year overall and progression-free survival for all patients was 38% and 29%, respectively, and 65% and 60% respectively for patients proceeding to stem cell transplant. Long-term remission was achieved in 45% of patients achieving a partial response (PR) to initial induction therapy and <20% of patients with stable or progression of disease following initial therapy. These results suggest that salvage chemotherapy with the intent of subsequent high-dose therapy and ASCT remains a feasible strategy in certain patients with primary refractory DLBCL, particularly for those achieving a PR to frontline therapy. The primary barrier to curative therapy in patients with primary refractory disease is resistance to salvage therapy, and future studies should be aimed towards increasing the response rate in this population.
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Affiliation(s)
- Santosha A. Vardhana
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig S. Sauter
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J. Matasar
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D. Zelenetz
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Galasso
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M. Woo
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H. Moskowitz
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Chaganti S, Illidge T, Barrington S, Mckay P, Linton K, Cwynarski K, McMillan A, Davies A, Stern S, Peggs K. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol 2016; 174:43-56. [PMID: 27196701 DOI: 10.1111/bjh.14136] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Humans
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Disease Management
- Doxorubicin/therapeutic use
- Frailty/therapy
- HIV Infections/complications
- HIV Infections/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/therapy
- Prednisone/therapeutic use
- Rituximab
- Salvage Therapy/methods
- United Kingdom
- Vincristine/therapeutic use
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Affiliation(s)
- Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Illidge
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Sally Barrington
- PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Pam Mckay
- Department of Haematology, West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Linton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | | | - Andy Davies
- Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - Simon Stern
- Department of Haematology, St Helier Hospital, Carshalton, UK
| | - Karl Peggs
- Department of Haematology, University College Hospital, London, UK
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13
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Khattry N, Gupta A, Jain R, Gore A, Thippeswamy R, Jeevangi N, Kannan S, Nair R, Saikia T. LACE versus BEAM conditioning in relapsed and refractory lymphoma transplant: retrospective multicenter analysis of toxicity and efficacy. Int J Hematol 2016; 103:292-8. [PMID: 26729297 DOI: 10.1007/s12185-015-1927-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 11/26/2022]
Abstract
We compared the lomustine, cytarabine, cyclophosphamide and etoposide (LACE) and BCNU, etoposide, cytarabine, melphalan (BEAM) conditioning regimens for toxicity, engraftment kinetics, and efficacy in 139 patients undergoing autologous hematopoietic stem cell transplant for primary refractory or relapsed lymphoma. Ninety-two patients with Hodgkin lymphoma and 47 with non-Hodgkin lymphoma were enrolled. Seventy-five patients received LACE while 64 received BEAM. The incidence of grade 3-4 oral mucositis (9 vs 38%; P < 0.001) and parenteral nutrition requirement (32 vs 69%; P < 0.001) were significantly lower in the LACE cohort. The median days to myeloid (10 vs 11; P = 0.007) and platelet engraftment (13 vs 15; P = 0.026) were shorter for the LACE cohort. Transplant-related mortality in the LACE group was 9% compared to 13% in patients treated with BEAM (P = NS). The probability of overall survival (OS) and progression-free survival (PFS) at 5 years for entire cohort was 46 and 41%, respectively. Probability of OS (LACE 46% vs BEAM 47%; P = NS) and PFS (LACE 37% vs BEAM 47%; P = NS) at 5 years was comparable between two groups. We conclude that LACE has better toxicity profile compared to BEAM and results in similar long-term survival in primary refractory or relapsed lymphoma transplant.
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Affiliation(s)
- Navin Khattry
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
| | - Alok Gupta
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Reetu Jain
- Department of Medical Oncology, Jaslok Hospital, Mumbai, India
| | - Adwaita Gore
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Ravi Thippeswamy
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Nandish Jeevangi
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Sadhana Kannan
- Department of Biostatistics, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Reena Nair
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
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14
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Montassier E, Gastinne T, Vangay P, Al-Ghalith GA, Bruley des Varannes S, Massart S, Moreau P, Potel G, de La Cochetière MF, Batard E, Knights D. Chemotherapy-driven dysbiosis in the intestinal microbiome. Aliment Pharmacol Ther 2015; 42:515-28. [PMID: 26147207 DOI: 10.1111/apt.13302] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/16/2015] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chemotherapy is commonly used as myeloablative conditioning treatment to prepare patients for haematopoietic stem cell transplantation (HSCT). Chemotherapy leads to several side effects, with gastrointestinal (GI) mucositis being one of the most frequent. Current models of GI mucositis pathophysiology are generally silent on the role of the intestinal microbiome. AIM To identify functional mechanisms by which the intestinal microbiome may play a key role in the pathophysiology of GI mucositis, we applied high-throughput DNA-sequencing analysis to identify microbes and microbial functions that are modulated following chemotherapy. METHODS We amplified and sequenced 16S rRNA genes from faecal samples before and after chemotherapy in 28 patients with non-Hodgkin's lymphoma who received the same myeloablative conditioning regimen and no other concomitant therapy such as antibiotics. RESULTS We found that faecal samples collected after chemotherapy exhibited significant decreases in abundances of Firmicutes (P = 0.0002) and Actinobacteria (P = 0.002) and significant increases in abundances of Proteobacteria (P = 0.0002) compared to samples collected before chemotherapy. Following chemotherapy, patients had reduced capacity for nucleotide metabolism (P = 0.0001), energy metabolism (P = 0.001), metabolism of cofactors and vitamins (P = 0.006), and increased capacity for glycan metabolism (P = 0.0002), signal transduction (P = 0.0002) and xenobiotics biodegradation (P = 0.002). CONCLUSIONS Our study identifies a severe compositional and functional imbalance in the gut microbial community associated with chemotherapy-induced GI mucositis. The functional pathways implicated in our analysis suggest potential directions for the development of intestinal microbiome-targeted interventions in cancer patients.
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Affiliation(s)
- E Montassier
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - T Gastinne
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - P Vangay
- Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA
| | - G A Al-Ghalith
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.,Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA
| | - S Bruley des Varannes
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - S Massart
- Gembloux Agro-Bio Tech, University of Liège, Gembloux, Belgium
| | - P Moreau
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - G Potel
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France
| | - M F de La Cochetière
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, INSERM, Université de Nantes, Nantes, France
| | - E Batard
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France
| | - D Knights
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.,BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
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15
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Parrish C, Rahemtulla A, Cavet J, Pearce RM, Kirkland K, Lee J, Cook M, Wilson K, Cook G. Autologous Stem Cell Transplantation Is an Effective Salvage Therapy for Primary Refractory Multiple Myeloma. Biol Blood Marrow Transplant 2015; 21:1330-4. [DOI: 10.1016/j.bbmt.2015.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
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16
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Jang HR, Song MK, Chung JS, Yang DH, Lee JO, Hong J, Cho SH, Kim SJ, Shin DH, Park YJ, Kang JS, Lee JE, Lee MW, Shin HJ. Maximum standardized uptake value on positron emission tomography/computed tomography predicts clinical outcome in patients with relapsed or refractory diffuse large B-cell lymphoma. Blood Res 2015; 50:97-102. [PMID: 26157779 PMCID: PMC4486165 DOI: 10.5045/br.2015.50.2.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/11/2015] [Accepted: 04/02/2015] [Indexed: 12/01/2022] Open
Abstract
Background Few clinical studies have clarified the prognostic factors that affect clinical outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after immunochemotherapy. Methods A total of 158 patients with relapsed or refractory DLBCL were enrolled. All patients underwent positron emission tomography/computed tomography (PET/CT) before and after salvage therapy. All enrolled patients previously received the ifosfamide, carboplatin, and etoposide regimen. Clinical outcomes were compared according to several factors (age ≥ 65 years, low age-adjusted International Prognostic Index [aa-IPI], maximum standardized uptake value [SUVmax] <6.0 on PET/CT, time to relapse ≥12 months, complete response after salvage therapy). A low aa-IPI, SUVmax <6.0, and time to relapse ≥ 12 months were independent prognostic factors for survival. Results In univariate analysis and multivariate analysis, SUVmax below 6.0 (P<0.001 for progression-free survival (PFS), P<0.001 for overall survival (OS)) and low aa-IPI (P<0.001 for PFS, P<0.001 for OS) were independent prognostic factors associated with favorable outcome. Conclusion The aa-IPI and initial SUVmax were powerful prognostic factors in patients with relapsed or refractory DLBCL.
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Affiliation(s)
- Hee Ryeong Jang
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Moo Kon Song
- Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea
| | - Joo Seop Chung
- Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea
| | - Deok Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jeong Ok Lee
- Department of Hematology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junshik Hong
- Department of Hematology, Gachon University Gil Hospital, Incheon, Korea
| | - Su Hee Cho
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Joo Park
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jin-Suk Kang
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Ho-Jin Shin
- Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea
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17
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Collins DT, Mannina EM, Mendonca M. Total body irradiation in a patient with fragile X syndrome for acute lymphoblastic leukemia in preparation for stem cell transplantation: A case report and literature review. Am J Med Genet A 2015; 167A:2444-6. [PMID: 26097012 DOI: 10.1002/ajmg.a.37204] [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: 10/23/2014] [Revised: 04/29/2015] [Accepted: 05/25/2015] [Indexed: 11/08/2022]
Abstract
Fragile X syndrome (FXS) is a congenital disorder caused by expansion of CGG trinucleotide repeat at the 5' end of the fragile X mental retardation gene 1 (FMR1) on the X chromosome that leads to chromosomal instability and diminished serum levels of fragile X mental retardation protein (FMRP). Afflicted individuals often have elongated features, marfanoid habitus, macroorchidism and intellectual impairment. Evolving literature suggests the condition may actually protect from malignancy while chromosomal instability would presumably elevate the risk. Increased sensitivity to ionizing radiation should also be predicted by unstable sites within the DNA. Interestingly, in this report, we detail a patient with FXS diagnosed with acute lymphoblastic leukemia treated with induction followed by subsequent cycles of hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) with a complete response who then was recommended to undergo peripheral stem cell transplantation. The patient underwent total body irradiation (TBI) as a component of his conditioning regimen and despite the concern of his clinicians, developed minimal acute toxicity and successful engraftment. The pertinent literature regarding irradiation of patients with FXS is also reviewed.
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Affiliation(s)
| | - E M Mannina
- Indiana University School of Medicine, Department of Radiation Oncology
| | - M Mendonca
- Indiana University School of Medicine, Department of Radiation Oncology
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18
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Chow E, Rao KV, Wood WA, Covington D, Armistead PM, Coghill J, Serody JS, Gabriel DA, Jamieson KJ, Park YA, Raval JS, Shea TC. Effectiveness of an Algorithm-Based Approach to the Utilization of Plerixafor in Patients Undergoing Chemotherapy-Based Stem Cell Mobilization. Biol Blood Marrow Transplant 2014; 20:1064-8. [DOI: 10.1016/j.bbmt.2014.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
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19
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Qiao W, Zhao J, Xing Y, Wang C, Wang T. Predictive value of [¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography for clinical outcome in patients with relapsed/refractory diffuse large B-cell lymphoma prior to and after autologous stem cell transplant. Leuk Lymphoma 2013; 55:276-82. [PMID: 23617323 DOI: 10.3109/10428194.2013.797974] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated the predictive value of [(18)F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) for clinical outcome such as progression-free survival (PFS) and overall survival (OS) in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) prior to and after autologous stem cell transplant (ASCT). FDG-PET/computed tomography (CT) was performed in 39 consecutive patients with relapsed/refractory DLBCL scheduled for ASCT. The median follow-up of surviving patients was 3 years (range 19-66 months). Both pre- and post-ASCT, FDG-PET findings were strongly correlated with PFS and OS (p < 0.005). The 2-year PFS estimates for FDG-negative versus -positive patients were 84.8% vs. 36.8% (pre-) and 81.1% vs. 13.3% (post-). The 2-year OS estimates in these groups were 95.5% vs. 68.3% (pre-) and 92.7% vs. 57.1% (post-). Patients were classified into three groups according to FDG-PET results before and after ASCT. The median PFS was significantly lower in the +/+ group (13.0 months) as compared with the +/- group (31.0 months, p = 0.021) and the -/- group (p = 0.000). The regression model showed that the predictive value of FDG-PET before ASCT owed its significance to a very high hazard ratio between patients with positive and negative imaging (p < 0.01). FDG-PET prior to and following ASCT in patients with relapsed or refractory DLBCL contains prognostic information on long-term clinical outcome.
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20
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Abdel-Rahman F, Tuffaha HW, Sharma S, Jazar HA, Hussein N, Saad A, Al Rawi O, Hussein A. GCSF with or without chemotherapy compared to Plerixafor with GCSF as salvage mobilization regimen in patients with multiple myeloma and lymphoma: collection effectiveness and cost effectiveness analysis. J Oncol Pharm Pract 2013; 20:130-6. [PMID: 23676506 DOI: 10.1177/1078155213484785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Plerixafor is a novel mobilizing agent of peripheral blood stem cells (PBSCs) in lymphoma and multiple myeloma (MM) patients whose cells mobilize poorly. Due to the substantial cost associated with its use, we aimed to compare the effectiveness and cost effectiveness of Plerixafor + GCSF (PG) versus GCSF ± Chemotherapy (GC) as salvage mobilization regimens. METHODS The charts of consecutive lymphoma and MM patients who had undergone at least one previous attempt of PBSCs mobilization that failed or resulted in an insufficient cell dose for transplant between 2007 and 2010 were retrospectively reviewed. Patients identified received salvage mobilization with GC (prior to 2009) or PG after Plerixafor's FDA approval. Data collected included demographics, medical histories, apheresis yields and transplant outcome. The cost effectiveness analysis was from the perspective of the Jordanian Ministry of Health. The incremental cost effectiveness ratio (ICER) was calculated by dividing the difference in cost by the difference in effectiveness for the two regimens. RESULTS Five patients received GC and twelve received PG. A minimum CD34+ cell dose of 2 × 10(6) cells/kg was collected from 8 patients (67%) in the PG group compared to 3 (60%) in the GC group (p=0.79). The average costs were US$8570 and US$25,700 for the GC group and the PG group, respectively. The ICER was US$244,714 per successful stem cell collection. CONCLUSION Salvage Plerixafor use showed a non-significant improvement in PBSCs collection with a significant increase in cost. Prospective comparative effectiveness studies are warranted to inform the optimal salvage mobilization regimen. To our knowledge, this is the first study from the Middle East to describe the effectiveness and cost effectiveness of Plerixafor.
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Affiliation(s)
- Fawzi Abdel-Rahman
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
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21
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Sebban C, Lefranc A, Perrier L, Moreau P, Espinouse D, Schmidt A, Kammoun L, Ghesquieres H, Ferlay C, Bay JO, Lissandre S, Pérol D, Michallet M, Quittet P. A randomised phase II study of the efficacy, safety and cost-effectiveness of pegfilgrastim and filgrastim after autologous stem cell transplant for lymphoma and myeloma (PALM study). Eur J Cancer 2012; 48:713-20. [PMID: 22248711 DOI: 10.1016/j.ejca.2011.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/18/2011] [Indexed: 11/27/2022]
Abstract
AIM To evaluate in a multicentre randomised study the effect on duration of febrile neutropenia (FN), the safety and cost-effectiveness of a single subcutaneous pegfilgrastim injection compared with daily injections of filgrastim after peripheral blood stem cell transplantation in patients receiving high dose chemotherapy for myeloma and lymphoma. METHODS Patients were randomly assigned to a single dose of pegfilgrastim at day 5 (D5) or daily filgrastim from D5 to the recovery of absolute neutrophil count (ANC) to 0.5 G/L. Duration of FN, of neutrophil and platelet recovery, transfusion and antibiotic requirements were the main end-points of the study. Costs were calculated from D0 until transplant unit discharge. The incremental cost-effectiveness ratio was expressed as the cost per day of FN prevented. Probabilistic sensitivity analysis was performed by non-parametric bootstrap methods. RESULTS Between October 2008 and September 2009, 10 centres enrolled 151 patients: 80 patients with lymphoma and 71 patients with myeloma. The mean duration of FN was 3.07 days (standard deviation (SD) 1.96) in the pegfilgrastin arm and 3.29 (SD 2.54) in the filgrastim one. Mean total costs were 23,256 and 25,448 euros for pegfilgrastim and filgrastim patients, respectively. There was a 62% probability that pegfilgrastim strictly dominates filgrastim. CONCLUDING STATEMENT Pegfilgrastim after PBSC transplantation in myeloma and lymphoma is safe, effective when compared with filgrastim and could represent a cost-effective alternative in this setting.
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Affiliation(s)
- C Sebban
- Hematology Department, Cancer Centre Léon Bérard, Lyon, France.
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22
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Abhyankar S, DeJarnette S, Aljitawi O, Ganguly S, Merkel D, McGuirk J. A risk-based approach to optimize autologous hematopoietic stem cell (HSC) collection with the use of plerixafor. Bone Marrow Transplant 2011; 47:483-7. [DOI: 10.1038/bmt.2011.133] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Liu HW, Seftel MD, Rubinger M, Szwajcer D, Demers A, Nugent Z, Schroeder G, Butler JB, Cooke A. Total Body Irradiation Compared With BEAM: Long-Term Outcomes of Peripheral Blood Autologous Stem Cell Transplantation for Non-Hodgkin's Lymphoma. Int J Radiat Oncol Biol Phys 2010; 78:513-20. [DOI: 10.1016/j.ijrobp.2009.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 07/30/2009] [Accepted: 08/11/2009] [Indexed: 11/29/2022]
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24
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Pocali B, De Simone M, Annunziata M, Palmieri S, D'Amico MR, Copia C, Viola A, Mele G, Schiavone EM, Ferrara F. Ifosfamide, Epirubicin and Etoposide (IEV) Regimen as Salvage and Mobilization Therapy for Refractory or Early Relapsing Patients with Aggressive Non-Hodgkin's Lymphoma. Leuk Lymphoma 2009; 45:1605-9. [PMID: 15370212 DOI: 10.1080/10428190410001683651] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The prognosis of early relapsing or refractory aggressive non-Hodgkin's lymphoma (NHL) is still poor. Effective salvage therapy should be able to induce high response rate as well as to mobilize hematopoietic precursors. A combination of ifosfamide, epirubicin and etoposide (IEV) was given to 28 patients with refractory or relapsing high grade NHL (4 lymphoblastic lymphoma and 24 large cell lymphoma). All patients were evaluated for response. After 2 courses of IEV, the overall and complete response rate were 64% and 39%, respectively. All patients were controlled for mobilization of peripheral blood stem cells, which was successful in 26 out of 28 (93%). Overall, 25 out of 26 patients proceeded to autologous stem cell transplantation (ASCT). Toxicity was mild, with no occurrence of severe persisting extra-hematologic side-effects. Following the entire therapeutic program, including IEV and ASCT, median progression free survival has not yet been reached and 21 patients are alive (18 in continuous complete remission) after a median follow-up of 18 months. Our results demonstrate that treatment with IEV regimen is effective in refractory or relapsing aggressive NHL, resulting in a high percentage of successful stem cell mobilization and feasibility of ASCT.
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Affiliation(s)
- Barbara Pocali
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Napoli, Italy
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25
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Keeney GE, Gooley TA, Pham RN, Press OW, Pagel JM, Petersdorf SH, Maloney DG, Bensinger W, Holmberg L, Gopal AK. The pretransplant Follicular Lymphoma International Prognostic Index is associated with survival of follicular lymphoma patients undergoing autologous hematopoietic stem cell transplantation. Leuk Lymphoma 2009; 48:1961-7. [DOI: 10.1080/10428190701583983] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Puig N, de la Rubia J, Remigia MJ, Jarque I, Martín G, Cupelli L, Sanz GF, Lorenzo I, Sanz J, Martínez JA, Jiménez C, Sanz MA. Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation. Leuk Lymphoma 2009; 47:1488-94. [PMID: 16966258 DOI: 10.1080/10428190500527769] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
CBV and BEAM are the two most frequently used regimens for patients with lymphoma undergoing autologous hematopoietic stem-cell transplantation (ASCT). This study compared their morbidity and transplant-related mortality (TRM) in 113 patients with non-Hodgkin's lymphoma (69) and Hodgkin's disease (44) undergoing ASCT between 1990 - 2004. CBV (cyclophosphamide, 6000 mg m(-2); VP-16, 750 mg m(-2); and high-dose BCNU, 800 mg m(-2)) was administered to 75 patients and 38 received BEAM (BCNU, 300 mg m(-2); VP-16, 800 mg m(-2); cytarabine, 800 mg m(-2); melphalan, 140 mg m(-2)). Patients in the BEAM group had a significantly higher median age (p = 0.002) and were more heavily treated before ASCT (p = 0.003). More patients showed active disease at transplant in the BEAM group (p = 0.04). Sinusoidal obstruction syndrome (SOS) was more frequent in the CBV group (11% vs 0%, p = 0.048). There were 20 (18%) transplant-related deaths, 18 in the CBV and two in the BEAM group. Infectious complications (12 patients, seven with pneumonia) and SOS (four) were the most frequent causes of death. The cumulative incidences of TRM were 25% in the CBV and 7% in the BEAM group (p = 0.02). CBV thus produced a higher incidence of SOS and TRM than BEAM in this series.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/toxicity
- Carmustine/administration & dosage
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Etoposide/administration & dosage
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Hematopoietic Stem Cell Transplantation/mortality
- Hepatic Veno-Occlusive Disease/chemically induced
- Hepatic Veno-Occlusive Disease/mortality
- Humans
- Infections/chemically induced
- Infections/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphoid/complications
- Leukemia, Lymphoid/epidemiology
- Leukemia, Lymphoid/mortality
- Leukemia, Lymphoid/therapy
- Male
- Melphalan/administration & dosage
- Middle Aged
- Morbidity
- Mortality
- Podophyllotoxin/administration & dosage
- Transplantation Conditioning/adverse effects
- Transplantation Conditioning/methods
- Transplantation Conditioning/mortality
- Transplantation, Autologous
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Affiliation(s)
- Noemí Puig
- Hematology Service, University Hospital La Fe, Valencia, Spain
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Vose JM, Panwalkar A, Belanger R, Coiffier B, Baccarani M, Gregory SA, Facon T, Fanin R, Caballero D, Ben-Yehuda D, Giles F. A phase II multicenter study of troxacitabine in relapsed or refractory lymphoproliferative neoplasms or multiple myeloma. Leuk Lymphoma 2009; 48:39-45. [PMID: 17325846 DOI: 10.1080/10428190600909578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Options for patients with relapsed/refractory lymphoproliferative disorders and multiple myeloma are currently limited. Troxacitabine has shown promise in preclinical studies in a variety of malignancies; hence, the current study was conducted to evaluate the activity of troxacitabine in relapsed or refractory lymphoid malignancies. This was a phase II, open-label, multinational, multicenter study of patients with relapsed or refractory lymphoproliferative disorders or multiple myeloma. Thirty-four adults were enrolled in the study and received the study drug at either 5.4 mg/m2 (n = 16) or 4.3 mg/m2 (n = 18). The dose was decided in a phase I study, during which dose escalation was carried to reach a maximum tolerated dose with an acceptable toxicity profile. Two separate phase I studies were performed in Europe and the US. Troxacitabine was administered by intravenous infusion over 30 min daily for days 1 - 5 every 4 weeks. Treatment was continued to disease progression or until the subjects met criteria for withdrawal or unacceptable toxicities were evident as outlined in the protocol. Two patients had a partial response (PR) to treatment with troxacitabine to yield an overall response rate of 13%. There were no complete responses seen with the drug. Stable disease was achieved in 15 patients (44%). All patients had at least one treatment related adverse event, which led to six withdrawals from the study. Hematologic toxicity constituted the most common adverse events. Serious adverse effects were seen in 62% of patients. None of the 13 deaths were attributed directly to troxacitabine. As a single agent, troxacitabine has limited benefit in patients with advanced lymphoproliferative disorders or multiple myeloma. Future studies will be needed to address modified dosing according to emerging pharmacokinetic and pharmacodynamic data and combination therapy which may lead to improved clinical benefit for troxacitabine in hematologic malignancies.
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Affiliation(s)
- Julie M Vose
- University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Ko OB, Jang G, Kim S, Huh J, Suh C. Autologous stem cell transplantation for diffuse large B-cell lymphoma with residual extranodal involvement. Korean J Intern Med 2008; 23:182-90. [PMID: 19119255 PMCID: PMC2687679 DOI: 10.3904/kjim.2008.23.4.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Diffuse large B-cell lymphoma (DLBCL) in Koreans is frequently accompanied by extranodal (EN) disease at the time of autologous stem cell transplantation (ASCT). We sought to determine whether high EN involvement affected survival following ASCT in Koreans. METHODS We reviewed 27 patients who had DLBCL with residual disease at ASCT: 13 with residual disease at nodal site(s) only and 14 with nodal and EN disease. RESULTS Univariate analysis showed that disease status, lactate dehydrogenase (LDH), and performance status at ASCT were predictors of survival following ASCT. The number of EN sites, as categorized by the International Prognostic Index system, had no prognostic significance. When EN involvement at ASCT was classified as negative or positive, the 2-year overall survival for the negative group was 64%, significantly better than the 14% for the positive group (p=0.021), and the event-free survival for the negative group was 62%, significantly better than the 14% for the positive group (p=0.02). CONCLUSIONS Patients who had DLBCL with residual EN involvement at ASCT showed worse outcomes following ASCT compared to those without EN disease.
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Affiliation(s)
- Ock Bae Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geundoo Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Derenzini E, Musuraca G, Fanti S, Stefoni V, Tani M, Alinari L, Venturini F, Gandolfi L, Baccarani M, Zinzani PL. Pretransplantation positron emission tomography scan is the main predictor of autologous stem cell transplantation outcome in aggressive B-cell non-Hodgkin lymphoma. Cancer 2008; 113:2496-503. [PMID: 18833583 DOI: 10.1002/cncr.23861] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Limited data exist about the role of second-line chemotherapy response assessed by positron emission tomography (PET) as a prognostic factor in patients with aggressive non-Hodgkin Lymphoma (NHL) who undergo autologous stem cell transplantation (ASCT). The objective of this analysis was to investigate the main determinants of prognosis in patients with aggressive B-cell NHL who undergo ASCT, focusing on the impact of pretransplantation PET, secondary age-adjusted International Prognostic Index (sAA-IPI) score, histology, and previous response to first-line chemotherapy. METHODS Seventy-five patients with diffuse, large B-cell lymphoma or grade 3 follicular lymphoma who were treated at the author' institution with second-line chemotherapy (combined ifosfamide, etoposide, and epirubicin [IEV]) followed by ASCT between September 2002 and September 2006 were included. All patients were evaluated by PET after 1 to 3 courses of IEV chemotherapy before ASCT, and all patients received a conditioning regimen of combined carmustine, etoposide, cytosine arabinoside, and melphalan. The prognostic impact of pretransplantation PET, sAA-IPI score, histology, and previous response to first-line chemotherapy was evaluated by univariate and multivariate analyses. RESULTS Seventy-two of 75 patients underwent ASCT. In a univariate analysis for progression-free survival (PFS) and overall survival (OS), a significant association was observed with pretransplantation PET (PFS, P< .00001; OS, P< .01) and previous first-line response (PFS, P= .02; OS, P= .04). In the multivariate framework, pretransplantation PET was identified as the only independent prognostic factor (PFS, P< .001; OS, P= .01). CONCLUSIONS The current data indicated that pretransplantation PET is the main prognostic predictor in patients with aggressive B-cell NHL who are scheduled for ASCT.
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Affiliation(s)
- Enrico Derenzini
- Institute of Hematology and Medical Oncology L. & A. Seràgnoli, University of Bologna, Bologna, Italy.
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Costa LJ, Micallef IN, Inwards DJ, Johnston PB, Porrata LF, Litzow MR, Ansell SM. Effect of the dose per body weight of conditioning chemotherapy on severity of mucositis and risk of relapse after autologous haematopoietic stem cell transplantation in relapsed diffuse large B cell lymphoma. Br J Haematol 2008; 143:268-73. [DOI: 10.1111/j.1365-2141.2008.07342.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Alousi AM, Saliba RM, Okoroji GJ, Macapinlac HA, Hosing C, Korbling M, Samuels BI, Popat U, Kebriaei P, Anderlini P, Qazilbash MH, de Lima M, Giralt SA, Champlin RE, Khouri IF. Disease staging with positron emission tomography or gallium scanning and use of rituximab predict outcome for patients with diffuse large B-cell lymphoma treated with autologous stem cell transplantation. Br J Haematol 2008; 142:786-92. [PMID: 18564354 DOI: 10.1111/j.1365-2141.2008.07277.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tumor status, as determined by positron emission tomography or gallium scanning (PET/G), may be an important predictor of outcome for patients with diffuse large B-cell lymphoma (DLBCL) undergoing autologous stem cell transplantation (ASCT). ASCT conditioning regimens that include rituximab may reduce the rate of relapse. We evaluated the influence of rituximab on overall and progression-free survival in patients with DLBCL based on PET/G status before ASCT. A retrospective review of all patients with chemosensitive DLBCL who underwent ASCT in the context of research protocols at our institution between 1995 and 2005 was performed. Our study included 174 patients. Disease status before ASCT, according to PET/G, was negative in 136 patients (78%), positive in 29 patients (17%), and unknown in nine patients (5%). PET/G status and rituximab use were the only factors predictive of progression-free survival in multivariate analyses: the hazard ratios for relapse were 2.9 for PET/G-positive versus -negative patients (P < 0.001) and 0.4 for rituximab versus no rituximab use (P = 0.001). We conclude that evidence of disease on PET/G scanning prior to transplantation is associated with an increased risk for relapse after ASCT. Transplantation regimens containing rituximab can reduce this risk, regardless of PET/G status.
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Affiliation(s)
- Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Prognostic impact of pre-transplantation computed tomography and 67gallium scanning in chemosensitive diffuse large B cell lymphoma patients undergoing hematopoietic stem-cell transplantation. Ann Nucl Med 2008; 22:251-60. [PMID: 18535875 DOI: 10.1007/s12149-007-0124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the present study, we evaluated computed tomography (CT) and (67)gallium scanning ((67)Ga scan) pre-transplant as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with diffuse large B cell lymphoma, undergoing high-dose chemotherapy and stem-cell transplantation. PATIENTS AND METHODS Forty-two patients were included. Of these, 9 (21%) had both positive CT and (67)Ga scans, 17 (41%) negative results with both techniques, and 16 (38%) positive CT/negative (67)Ga scan. Whole-body planar imaging and single-photon emission computed tomography (SPECT) were performed 72 h after an intravenous administration of (67)Ga citrate measuring between 7 mCi and 10 mCi (259-370 MBq). RESULTS Patients with positive CT/positive (67)Ga scan had a significantly worse EFS and OS at 5 years than those with negative (67)Ga scan regardless of whether it was associated with a positive or a negative CT scan (29% and 16% vs. 81% and 93% vs. 88% and 100%, respectively, P < 0.001). After a median follow-up of 43 months (range 4-130 months), no differences were observed between patients with negative CT/negative (67)Ga scan and those with positive CT/negative (67)Ga scan, with an EFS and OS at 5 years of 88% versus 81% and 100% versus 93%, respectively. In multivariate analysis, the presence of a pre-transplant positive CT/(67)Ga scans adversely influenced both EFS and OS [HR 8, 95% confidence interval (CI) (1.4-38), P = 0.03 and HR 2; 95% CI (1.3-8), P = 0.02, respectively]. CONCLUSIONS (67)Ga scan helps to identify, in the pre-transplant evaluation, two groups with a different outcome: one group of patients with positive CT and negative (67)Ga scans pre-transplant, who showed a favorable outcome with a low rate of relapse, and the other group of patients with both positive CT and (67)Ga scans pre-transplant, who showed a poor prognosis and did not benefit from autologous stem-cell transplantation. They should have been offered other therapeutic strategies.
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Hoppe BS, Moskowitz CH, Filippa DA, Moskowitz CS, Kewalramani T, Zelenetz AD, Yahalom J. Involved-Field Radiotherapy Before High-Dose Therapy and Autologous Stem-Cell Rescue in Diffuse Large-Cell Lymphoma: Long-Term Disease Control and Toxicity. J Clin Oncol 2008; 26:1858-64. [DOI: 10.1200/jco.2007.15.4773] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To analyze outcome, prognostic factors, and toxicities in patients with diffuse large-cell lymphoma (DLCL) who received involved-field radiotherapy (IFRT) before high-dose chemotherapy with autologous stem-cell rescue (ASCR). Patients and Methods Between January 1990 and August 2006, 164 patients with relapsed or refractory DLCL received IFRT at Memorial Sloan-Kettering Cancer Center (New York, NY) before high-dose chemotherapy and ASCR. IFRT was delivered to involved sites measuring more than 5 cm or to sites with residual disease more than 2 cm. Radiotherapy was administered in 1.5-Gy fractions twice daily to a total dose of 30 Gy. Progression-free survival and overall survival were calculated, and short- and long-term toxicity was assessed according to National Cancer Institute Common Toxicity Criteria (version 2.0). Median follow-up was 60 months (range, 2 to 187 months). Results Two- and 5-year progression-free survival was 62% and 53%; 2- and 5-year overall survival was 67% and 58%, respectively. Sixty-seven patients relapsed; only 10 patients relapsed completely within the radiotherapy field. There were seven early treatment-related mortalities and 11 secondary cancers (including four myelodysplastic syndromes), one of which occurred within the IFRT site and five after total-body irradiation. Conclusion Minimal treatment-related mortality and morbidity resulted from short, intensive, involved-field radiotherapy before high-dose chemotherapy and ASCR, which was incorporated into a salvage regimen for patients with relapsed/refractory DLCL. This chemoradiotherapy salvage regimen resulted in a low local relapse rate that could potentially translate into an improved total outcome.
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Affiliation(s)
- Bradford S. Hoppe
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Craig H. Moskowitz
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Daniel A. Filippa
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Chaya S. Moskowitz
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Tarun Kewalramani
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- From the Lymphoma Disease Management Team and the Departments of Radiation Oncology, Medical Oncology, Pathology, and Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
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Fox CP, McMillan AK, Bishton MJ, Haynes AP, Russell NH. IVE (ifosfamide, epirubicin and etoposide) is a more effective stem cell mobilisation regimen than ICE (ifosphamide, carboplatin and etoposide) in the context of salvage therapy for lymphoma. Br J Haematol 2008; 141:244-8. [DOI: 10.1111/j.1365-2141.2008.07068.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Time of relapse after initial therapy significantly adds to the prognostic value of the IPI-R in patients with relapsed DLBCL undergoing autologous stem cell transplantation. Bone Marrow Transplant 2008; 41:715-20. [DOI: 10.1038/sj.bmt.1705967] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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The Non-Hodgkin’s Lymphomas. Oncology 2007. [DOI: 10.1007/0-387-31056-8_68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Ferrucci PF, Vanazzi A, Grana CM, Cremonesi M, Bartolomei M, Chinol M, Ferrari M, Radice D, Papi S, Martinelli G, Paganelli G. High activity90Y-ibritumomab tiuxetan (Zevalin®) with peripheral blood progenitor cells support in patients with refractory/resistant B-cell non-Hodgkin lymphomas. Br J Haematol 2007; 139:590-9. [DOI: 10.1111/j.1365-2141.2007.06869.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Davies AJ. Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I(131) tositumomab. Oncogene 2007; 26:3614-28. [PMID: 17530015 DOI: 10.1038/sj.onc.1210378] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radioimmunotherapy, targeting the CD20 antigen, in B-cell lymphoma has clearly demonstrated efficacy and tolerability over the preceding 15 years. As a result, two products are available with Food and Drug Administration approval for marketing - Y(90) ibritumomab tiuxetan and I(131) tositumomab, given as the Zevalin and Bexxar therapeutic regimens, respectively. Both demonstrate high-response rates and durability of remission in the relapsed/refractory disease setting. Data are emerging regarding their utility as initial therapy, and furthermore, they are been investigated for use sequentially with chemotherapy, and in the myeloablative setting. As yet however, how to best use these agents in the clinical disease course remains uncertain.
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Affiliation(s)
- A J Davies
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK.
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Betticher DC, Martinelli G, Radford JA, Kaufmann M, Dyer MJS, Kaiser U, Aulitzky WE, Beck J, von Rohr A, Kovascovics T, Cogliatti SB, Cina S, Maibach R, Cerny T, Linch DC. Sequential high dose chemotherapy as initial treatment for aggressive sub-types of non-Hodgkin lymphoma: results of the international randomized phase III trial (MISTRAL). Ann Oncol 2006; 17:1546-52. [PMID: 16888080 DOI: 10.1093/annonc/mdl153] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Sequential high dose (SHiDo) chemotherapy with stem cell support has been shown to prolong the event-free survival in patients with diffuse large B-cell lymphoma. METHODS To confirm this result in a multicenter trial, we randomized patients with aggressive NHL, to receive either eight cycles of CHOP or SHiDo. The primary endpoint was overall survival. RESULTS 129 evaluable patients were randomized to receive either CHOP or SHiDo: median age, 48 years; 62% male; stage III+IV: 73%; age adjusted International Prognostic Index 1/2/3: 21%/52%/27%. Toxicity grades 3+4 were more pronounced in the SHiDo-arm with 13% versus 3% of patients with fever; 34% versus 13% with infections; 13% versus 2% with esophagitis/dysphagia/gastric ulcer. The remission rates were similar in SHiDo and CHOP arms with 34%/37% complete remissions and 31%/31% partial remissions, respectively. After a median observation time of 48 months, there was no difference in overall survival at 3 years, with 46% for SHiDo and 53% for CHOP (P = 0.48). CONCLUSION In this multicenter trial, early intensification with SHiDo did not confer any survival benefit in previously untreated patients with aggressive NHL and was associated with a higher incidence of grades 3/4 toxicity.
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Affiliation(s)
- D C Betticher
- SAKK (Swiss Group for Clinical Cancer Research), Bern, Switzerland.
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Abstract
OBJECTIVE To explore the role and outcomes using hematopoietic cell transplantation (HCT) as a treatment option with aggressive, follicular, mantle, T-cell, and HIV related non-Hodgkin's lymphoma (NHL). DATA SOURCES Research and review articles and textbooks. CONCLUSION High-dose chemotherapy and/or radiation therapy followed by HCT has been used to overcome resistance to standard-dose therapy and has been explored over the past 40 years and has shown long-term survival of approximately 10% to 50% in patients with relapsed or refractory lymphoma. IMPLICATIONS FOR NURSING PRACTICE Nursing plays a significant role in the assessment and management of patients throughout the course of HCT.
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MESH Headings
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/nursing
- Humans
- Lymphoma, AIDS-Related/nursing
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Follicular/nursing
- Lymphoma, Follicular/therapy
- Lymphoma, Mantle-Cell/nursing
- Lymphoma, Mantle-Cell/therapy
- Lymphoma, Non-Hodgkin/nursing
- Lymphoma, Non-Hodgkin/therapy
- Lymphoma, T-Cell/nursing
- Lymphoma, T-Cell/therapy
- Transplantation Conditioning/adverse effects
- Transplantation Conditioning/nursing
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Affiliation(s)
- Sharon K Steingass
- Department of Clinical Practice and Professional Education, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Krishnan A, Nademanee A, Fung H, Angelopoulou M, Molina A, Gaal K, Dagis A, Palmer J, Alvarnas J, Slovak M, Kogut N, Popplewell L, Rodriguez R, Schriber J, Wang S, Forman SJ. Does Follicularity in Large Cell Lymphoma Predict Outcome after Autologous Stem Cell Transplantation? Biol Blood Marrow Transplant 2006; 12:641-7. [PMID: 16737937 DOI: 10.1016/j.bbmt.2005.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 12/28/2005] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate whether follicular histology in large cell lymphoma influences treatment outcomes after autologous stem cell transplantation (ASCT). It remains an area of controversy whether the natural history of follicular large cell lymphoma (FLCL) is akin to diffuse large cell lymphoma (DLCL) with curative potential or is more similar to indolent follicular lymphomas with a pattern of late relapses after intensive chemotherapy. Although ASCT is a potentially curative treatment for patients with recurrent DLCL, the effectiveness of this approach in patients with FLCL is unclear. We undertook a retrospective analysis of 332 patients with large cell lymphoma who underwent ASCT at the City of Hope Comprehensive Cancer Center. With a median follow-up of 31 months, the projected 10-year overall survival and disease-free survival were similar between patients with FLCL and DLCL. Analysis of prognostic factors demonstrated that although age, chemotherapy refractoriness, and disease status at the time of ASCT were predictive of overall survival/disease-free survival, follicularity did not influence the outcome. Furthermore, the similar plateau in the survival curve for the DLCL and FLCL patients suggests that the behavior of FLCL is similar to that of DLCL and that FLCL is potentially curable with ASCT.
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MESH Headings
- Adult
- Bone Marrow/pathology
- Disease-Free Survival
- Follow-Up Studies
- Humans
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Predictive Value of Tests
- Retrospective Studies
- Stem Cell Transplantation
- Survival Analysis
- Transplantation, Autologous
- Treatment Outcome
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Affiliation(s)
- Amrita Krishnan
- Division of Hematology/Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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Liedtke M, Hamlin PA, Moskowitz CH, Zelenetz AD. Surveillance imaging during remission identifies a group of patients with more favorable aggressive NHL at time of relapse: a retrospective analysis of a uniformly-treated patient population. Ann Oncol 2006; 17:909-13. [PMID: 16672295 DOI: 10.1093/annonc/mdl049] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately one-third of the patients with relapsed aggressive non-Hodgkin's lymphoma (NHL) are cured by second-line chemotherapy followed by high-dose consolidation. The age-adjusted international prognostic index determined at the time of relapse (sAAIPI) predicts outcome in relapsed diffuse large B-cell lymphoma, suggesting that the success of salvage therapy could be enhanced by early relapse detection. This study evaluated the role of surveillance imaging in detection of relapsed disease and its impact on outcome of salvage treatment. PATIENTS AND METHODS One hundred and eight patients with relapsed aggressive NHL were treated with ICE-based second-line chemotherapy. Relapses were categorized as detected by imaging, examination, or patient-reported symptoms. RESULTS Twenty per cent of relapses were detected by routine imaging while 80% were identified by reported symptoms or abnormalities on exam. Patients were 4.1 times (95% CI: 1.7-10.2) more likely to have low risk disease if relapse was diagnosed by routine imaging (group 1) compared with those diagnosed by reported symptoms or physical findings (group 2). Median overall 5-year survival for group 1 versus group 2 was 54% and 43% respectively (P = 0.13). CONCLUSION These results suggest that routine surveillance imaging can identify a population of patients with a more favorable outcome based on the sAAIPI.
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Affiliation(s)
- M Liedtke
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, NY 10021, USA
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Hertzberg MS, Crombie C, Benson W, Taper J, Gottlieb D, Bradstock KF. Outpatient fractionated ifosfamide, carboplatin and etoposide as salvage therapy in relapsed and refractory non-Hodgkin's and Hodgkin's lymphoma. Ann Oncol 2006; 17 Suppl 4:iv25-30. [PMID: 16702181 DOI: 10.1093/annonc/mdj995] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have treated 75 transplant-eligible patients with relapsed or refractory lymphoma using an outpatient-based fractionated regimen of ifosfamide, carboplatin and etoposide (ICE) for both salvage and stem cell mobilisation. Patients included DLBC (n = 33), follicular (n = 23), NK/T-cell (n = 3), mantle cell (n = 3) and Hodgkin's lymphoma (n = 13). Cycles of outpatient ICE were given every 21 days and consisted of: ifosfamide 5000 mg/m(2) i.v. fractionated into three equally divided doses and infused over 2-3 h on days 1-3, carboplatin (mg dose = 5 x AUC) i.v. over 1 h on day 1; and etoposide 100 mg/m(2) i.v. daily on days 1-3, plus filgrastim 5 microg/kg/day. Most patients with indolent lymphoma also received rituximab. The median age of patients was 52 years (range 26-69 years). Patients received a mean of 2.8 cycles of ICE. Non-haematological toxicities included grade 1/2 CNS toxicity in four patients, cardiac toxicity in two, reversible renal impairment and haematuria in one each. Haematological toxicity included grades III/IV thrombocytopenia and neutropenia with at least one cycle of ICE in 71% and 72% of patients, respectively. The median time to PBSC harvest was 14 days (range 10-20 days), while the median CD34(+) cell yield was 4.8 x 10(6)/kg (range 2.3-37.8). Five patients (7%) failed to mobilise PBSCs. The overall response rate to ICE was 89%, comprising 29% who achieved a CR and 60% who achieved a PR; for DLBCL, the overall response rate was 85% including 36% who achieved a CR and 49% who exhibited a PR. At a median follow-up of 24 months, the Kaplan-Meier estimates of the overall and event-free survival for all patients were 65% and 42%, respectively. For patients with DLBCL overall and event-free survival figures were 51% and 35%, respectively, at a median follow-up of 14 months. These data confirm the efficacy and tolerability of outpatient fractionated ICE as both a salvage and mobilisation regimen in relapsed/refractory lymphoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Ambulatory Care
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carboplatin/therapeutic use
- Combined Modality Therapy
- Disease-Free Survival
- Etoposide/therapeutic use
- Female
- Hematopoietic Stem Cell Mobilization
- Hodgkin Disease/pathology
- Hodgkin Disease/therapy
- Humans
- Ifosfamide/therapeutic use
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Remission Induction
- Salvage Therapy
- Stem Cell Transplantation
- Survival Rate
- Transplantation, Autologous
- Treatment Outcome
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Affiliation(s)
- M S Hertzberg
- Department of Haematology, Westmead Hospital, Westmead, NSW 2145, Australia.
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44
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Flinn IW, Berdeja JG. Blood and bone marrow transplantation for patients with Hodgkin's and non-Hodgkin's lymphoma. Cancer Treat Res 2006; 131:251-81. [PMID: 16704172 DOI: 10.1007/978-0-387-29346-2_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Ian W Flinn
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Bunting-Blaustein Cancer Research Building, 1650 Orleans Street/Room 388, Baltimore, MD 21231-1000, USA
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45
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Zinzani PL. Autologous hematopoietic stem cell transplantation in Non-Hodgkin's lymphomas. Acta Haematol 2005; 114:255-9. [PMID: 16269866 DOI: 10.1159/000088416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early studies on high-dose therapy followed by autologous bone marrow transplantation demonstrated the safety and efficacy of this approach in non-Hodgkin's lymphoma (NHL). As the procedure became easier and safer with the introduction of peripheral blood progenitor cells instead of marrow, the popularity of this procedure declined. In the last decade, autologous hematopoietic stem cell transplantation has played an important role in front-line and salvage treatments of indolent and aggressive NHL.
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Affiliation(s)
- Pier Luigi Zinzani
- L. and A. Seràgnoli Institute of Hematology and Oncology, University of Bologna, Bologna, Italy.
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46
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Suh C, Kim SH, Kim HJ, Jang G, Kim EK, Ko OB, Kim S, Sohn HJ, Lee JS, Kim MW, Huh J. Prognostic factors in non-Hodgkin's lymphoma patients treated by autologous stem cell transplantation: a single center experience. Cancer Res Treat 2005; 37:294-301. [PMID: 19956530 DOI: 10.4143/crt.2005.37.5.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/11/2005] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Autologous stem cell transplantation (ASCT) is increasingly used in patients with non-Hodgkin's lymphoma (NHL). Various clinical parameters-were evaluated to obtain significant predictors of the outcome following ASCT in patients with NHL. MATERIALS AND METHODS Between April 1994 and December 2003, ASCT was performed on 80 patients with NHL at the Asan Medical Center. RESULTS Patients had various histological subtypes and disease status. The two year progression free survival (PFS) and overall survival for all patients were 34 and 31%, respectively. A univariate analysis showed the performance status, stage, modified extranodal involvement category, International Prognostic Index (IPI) at mobilization, disease status at mobilization, and history of radiation prior to mobilization as significant predictors of the outcome following ASCT. Four risk groups, with different 2 year PFS, were identified by the age adjusted IPI at mobilization (mAAIPI): low risk 44%; low intermediate risk 40%; high intermediate risk 19%; and high risk 0% (p=.0003). A multivariate analysis revealed 3 significant factors for the PFS: disease status, prior RT and mAAIPI. CONCLUSION The mAAIPI was found to be an independent predictor of the outcome of NHL patients undergoing ASCT. This powerful prognostic tool should be used to evaluate potential candidates for ASCT.
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Affiliation(s)
- Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Oyan B, Koc Y, Ozdemir E, Kars A, Turker A, Tekuzman G, Kansu E. Ifosfamide, Idarubicin, and Etoposide in Relapsed/Refractory Hodgkin Disease or Non-Hodgkin Lymphoma: A Salvage Regimen with High Response Rates before Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2005; 11:688-97. [PMID: 16125639 DOI: 10.1016/j.bbmt.2005.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 05/24/2005] [Indexed: 11/21/2022]
Abstract
To achieve long-term disease-free survival, high-dose therapy and autologous stem cell transplantation (ASCT) is the current standard approach in patients with relapsed or refractory Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL). Because chemosensitivity is a significant factor in determining transplantation eligibility, it is critical to select a salvage chemotherapy regimen that has the potential to induce a high response rate with low nonhematologic toxicity. In this phase II study, 49 patients with relapsed or refractory HD (n = 22) and NHL (n = 27) with a median age of 42 years were treated with an IIVP salvage regimen consisting of ifosfamide, idarubicin, and etoposide. Twenty-seven percent of the patients had primary refractory disease, whereas 22% and 51% had early and late relapses, respectively. As analyzed by intention to treat, 16 patients (33%) achieved complete remission and 21 patients (43%) achieved a partial response, leading to an overall response rate of 76% (63% in NHL and 91% in HD). In the univariate analysis, diagnosis (HD versus NHL), remission duration before the initiation of IIVP, disease bulk, increased lactate dehydrogenase, and the presence of "B" symptoms were significant factors affecting the response achieved by the IIVP regimen. Of 37 responders, 31 (84%) underwent high-dose therapy and transplantation. The probability of 4-year overall survival (OS) and event-free survival (EFS) in this group of patients who underwent ASCT was 67.7% and 49.1%, respectively. When compared with the patients who achieved a partial response, patients who achieved complete remission with the IIVP regimen had a significantly higher probability of 4-year EFS (67.3% versus 30%; P = .016) and 4-year OS (92.3% versus 39.2%; P = .003). In patients with HD, 4-year EFS and 4-year OS were 54.9% and 70.6%, respectively, without a significant difference with respect to the survival rates obtained in patients with NHL (43.6% and 63.6%, respectively). Common side effects observed during 102 cycles of therapy were grade 3 to 4 neutropenia (62%) and thrombocytopenia (58%). The IIVP regimen is a highly effective salvage regimen for patients with relapsed or refractory HD or NHL who are candidates for ASCT. Furthermore, the degree of response to IIVP predicts the posttransplantation outcome. However, close follow-up is necessary because of a high incidence of grade 3 to 4 hematologic toxicity.
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Affiliation(s)
- Basak Oyan
- Section of Medical Oncology, Hematopoietic Stem Cell Transplantation Unit, Hacettepe University, Institute of Oncology, Ankara, Turkey
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48
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Nademanee A, Forman S, Molina A, Fung H, Smith D, Dagis A, Kwok C, Yamauchi D, Anderson AL, Falk P, Krishnan A, Kirschbaum M, Kogut N, Nakamura R, O'donnell M, Parker P, Popplewell L, Pullarkat V, Rodriguez R, Sahebi F, Smith E, Snyder D, Stein A, Spielberger R, Zain J, White C, Raubitschek A. A phase 1/2 trial of high-dose yttrium-90-ibritumomab tiuxetan in combination with high-dose etoposide and cyclophosphamide followed by autologous stem cell transplantation in patients with poor-risk or relapsed non-Hodgkin lymphoma. Blood 2005; 106:2896-902. [PMID: 16002426 PMCID: PMC1895300 DOI: 10.1182/blood-2005-03-1310] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We conducted a phase 1/2 trial of high-dose 90Y-ibritumomab tiuxetan in combination with high-dose etoposide (VP-16) 40 to 60 mg/kg (day -4) and cyclophosphamide 100 mg/kg (day -2) followed by autologous stem cell transplantation (ASCT) in 31 patients with CD20+ non-Hodgkin lymphoma (NHL). Patients underwent dosimetry (day -21) with 5 mCi (185 MBq) 111In-ibritumomab tiuxetan following 250 mg/m2 rituximab, followed a week later by 90Y-ibritumomab tiuxetan to deliver a target dose of 1000 cGy to highest normal organ. Bone marrow biopsy was done on day -7 to estimate radiation dose and stem cells were reinfused when the radiation dose was estimated to be less than 5 cGy. The median 90Y-ibritumomab tiuxetan dose was 71.6 mCi (2649.2 MBq; range, 36.6-105 mCi; range, 1354.2-3885 MBq). Histology included follicular lymphoma (n = 12), diffuse large B-cell (n = 14), and mantle cell (n = 5). The median number of prior chemo-therapy treatments was 2. The treatment was well tolerated. The median times to reach an absolute neutrophil count greater than 500/microL and platelet count more than 20,000/microL were 10 days and 12 days, respectively. There were 2 deaths and 5 relapses. At a median follow-up of 22 months, the 2-year estimated overall survival and relapse-free survival rates are 92% and 78%, respectively. We conclude that high-dose 90Y-ibritumomab tiuxetan can be combined safely with high-dose etoposide and cyclophosphamide without an increase in transplant-related toxicity or delayed engraftment.
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Affiliation(s)
- Auayporn Nademanee
- Division of Hematology and Hemapoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, USA.
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49
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Staber PB, Holub R, Linkesch W, Schmidt H, Neumeister P. Fixed-dose single administration of Pegfilgrastim vs daily Filgrastim in patients with haematological malignancies undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2005; 35:889-93. [PMID: 15765110 DOI: 10.1038/sj.bmt.1704927] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Infectious complications are frequent events in patients undergoing high-dose cytotoxic chemotherapy with subsequent autologous peripheral blood stem cell transplantation (PBSCT). To evaluate whether a single subcutaneous injection of pegfilgrastim (6 mg) is as safe and effective as daily filgrastim (5 mug/kg/day), 60 consecutive autologous stem cell transplantations performed for various haematological malignancies have been analysed. In total, 24 patients undergoing 30 consecutive PBSCT received a single subcutaneous injection of 6 mg pegfilgrastim on day 5 after transplantation and were compared retrospectively with 30 patients receiving 5 mug/kg/day of filgrastim starting from day 7 post transplantation. The mean duration of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 8.3 and 9.5 days, respectively (P=0.047). The results of the two groups were not significantly different for incidence of febrile neutropenia and toxicity profile. However, duration of febrile neutropenia (1.6 vs 3.0 days) and total days of fever (1.73 vs 4.1) were different (P=0.017 and 0.003, respectively), favouring the pegfilgrastim arm. Consequently, a higher incidence of transplants with documented infectious complications associated with the filgrastim group could be observed (56 vs 26%) (P=0.02). A single injection of pegfilgrastim administered at day 5 post transplant shows comparable safety and efficacy profiles to daily injections of filgrastim.
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Affiliation(s)
- P B Staber
- Division of Hematology, Medical University Graz, Graz, Austria
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50
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Kumar S, Lacy MQ, Dispenzieri A, Rajkumar SV, Fonseca R, Geyer S, Allmer C, Witzig TE, Lust JA, Greipp PR, Kyle RA, Litzow MR, Gertz MA. High-dose therapy and autologous stem cell transplantation for multiple myeloma poorly responsive to initial therapy. Bone Marrow Transplant 2005; 34:161-7. [PMID: 15133489 DOI: 10.1038/sj.bmt.1704545] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Autologous stem cell transplant (SCT) improves survival in multiple myeloma (MM) and remains the standard of care for eligible patients. Nearly a third of patients with newly diagnosed MM fail initial therapy aimed at reducing tumor burden preceding SCT (primary refractory). It is unclear if an initial response is important for successful SCT. We evaluated our experience with SCT in 50 patients with primary refractory MM and compared it to 101 patients with chemosensitive disease receiving SCT. The study cohort had a median age of 56 years (range 29-72) consisting of 87 males (58%). A total of 46 patients (92%) in the refractory group and 100 (99%) in the chemosensitive group had a response to transplant (50% or greater reduction in the M-protein). In all, 10 refractory patients (20%) and 35 (35%) in the chemosensitive group achieved a CR (P=0.06). The 1-year estimated progression-free survival from the time of transplant for the refractory group was 70% compared to 83% for the chemosensitive group (P=0.65). The lack of response to initial induction therapy does not appear to preclude a good response to SCT. We recommend that patients with primary refractory MM be offered early SCT.
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Affiliation(s)
- S Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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