Autologous stem cell transplantation for aggressive lymphomas

Disease characteristics of diffuse large B-cell lymphoma predicting relapse and survival after autologous stem cell transplantation: A single institution experience

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).

Safety and efficacy of bendamustine in the conditioning regimen for autologous stem cell transplantation in patients with relapsed/refractory lymphoma

Background

Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas.

Methods

We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT.

Results

Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×10⁶ CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days–19 mo). At the final follow-up, 7 patients (50%) were alive and in CR.

Conclusion

Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.

Comparison of therapeutic efficacy and complications between autologous stem cell transplantation and chemotherapy for large B-cell lymphoma: a meta-analysis

OBJECTIVE

To contrast the clinical effects and complications for the treatment of large B-cell lymphoma between autologous stem cell transplantation and chemotherapy.

METHODS

Multiple databases were searched to identify relevant studies. Articles that met the inclusion criteria were included.

RESULTS

A total of 11 studies including 795 patients were involved, which eventually met the eligibility criteria. 385 and 410 samples were included in ASCT group and chemotherapy group respectively. The heterogeneity test suggested that clinical efficacy (RR = 1.29, 95% CI [1.17, 1.42], P < 0.00001; P for heterogeneity = 0.0002, I² = 72%), side effects (RR = 1.72, 95% CI [1.15, 2.58], P = 0.009; P for Heterogeneity < 0.0001, I² = 85%) and overall 5-year survival rate (RR = 1.16, 95% CI [1.05, 1.29], P = 0.004; P for Heterogeneity = 0.008, I² = 58%) were significantly different between ASCT group and chemotherapy group, while non-disease 5-year survival rate (RR = 1.24, 95% CI [1.04, 1.48], P = 0.02; P for Heterogeneity = 0.22, I² = 24%) appears insignificantly.

CONCLUSIONS

This study presents a comprehensive summary and critical assessment of the current evidence for the treatment of large B-cell lymphoma. The evidence shows that the clinical efficacy of ASCT was better than that of chemotherapy to some extent, but ASCT might lead to more possibility of complications.