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McLaughlin P, Grillo-López AJ, Link BK, Levy R, Czuczman MS, Williams ME, Heyman MR, Bence-Bruckler I, White CA, Cabanillas F, Jain V, Ho AD, Lister J, Wey K, Shen D, Dallaire BK. Rituximab Chimeric Anti-CD20 Monoclonal Antibody Therapy for Relapsed Indolent Lymphoma: Half of Patients Respond to a Four-Dose Treatment Program. J Clin Oncol 2023; 41:154-162. [PMID: 36603541 DOI: 10.1200/jco.22.02403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The CD20 antigen is expressed on more than 90% of B-cell lymphomas. It is appealing for targeted therapy, because it does not shed or modulate. A chimeric monoclonal antibody more effectively mediates host effector functions and is itself less immunogenic than are murine antibodies. PATIENTS AND METHODS This was a multiinstitutional trial of the chimeric anti-CD20 antibody, IDEC-C2B8. Patients with relapsed low grade or follicular lymphoma received an outpatient treatment course of IDEC-C2B8 375 mg/m2 intravenously weekly for four doses. RESULTS From 31 centers, 166 patients were entered. Of this intent-to-treat group, 48% responded. With a median follow-up duration of 11.8 months, the projected median time to progression for responders is 13.0 months. Serum antibody levels were sustained longer after the fourth infusion than after the first, and were higher in responders and in patients with lower tumor burden. The majority of adverse events occurred during the first infusion and were grade 1 or 2; fever and chills were the most common events. Only 12% of patients had grade 3 and 3% grade 4 toxicities. A human antichimeric antibody was detected in only one patient. CONCLUSION The response rate of 48% with IDEC-C2B8 is comparable to results with single-agent cytotoxic chemotherapy. Toxicity was mild. Attention needs to be paid to the rate of antibody infusion, with titration according to toxicity. Further investigation of this agent is warranted, including its use in conjunction with standard chemotherapy.
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Affiliation(s)
- P McLaughlin
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - A J Grillo-López
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - B K Link
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - R Levy
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M S Czuczman
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M E Williams
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M R Heyman
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - I Bence-Bruckler
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - C A White
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - F Cabanillas
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - V Jain
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - A D Ho
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - J Lister
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - K Wey
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - D Shen
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - B K Dallaire
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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2
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Pettengell R, Uddin R, Boumendil A, Johnson R, Metzner B, Martín A, Romejko-Jarosinska J, Bence-Bruckler I, Giri P, Niemann CU, Robinson SP, Kimby E, Schmitz N, Dreger P, Goldstone AH, Montoto S. Durable benefit of rituximab maintenance post-autograft in patients with relapsed follicular lymphoma: 12-year follow-up of the EBMT lymphoma working party Lym1 trial. Bone Marrow Transplant 2021; 56:1413-1421. [PMID: 33452448 DOI: 10.1038/s41409-020-01182-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 01/16/2023]
Abstract
We report the 12-year follow-up of the prospective randomized EBMT LYM1 trial to determine whether the benefit of brief duration rituximab maintenance (RM) on progression-free survival (PFS) in patients with relapsed follicular lymphoma (FL) receiving an autologous stem cell transplant (ASCT) is sustained. One hundred and thirty-eight patients received RM with or without purging. The median follow-up after random assignment is 12 years (range 10-13) for the whole series. The 10-year PFS after ASCT is 47% (95% CI 40-54) with only 4 patients relapsing after 7.5 years. RM continues to significantly improve 10-year PFS after ASCT in comparison with NM [P = 0.002; HR 0.548 (95% CI 0.38-0.80)]. Ten-year non-relapse mortality (NRM) was not significantly different between treatment groups (7% overall). 10-year overall survival (OS) after ASCT was 75% (69-81) for the whole series, with no significant differences according to treatment sub-groups. 10-year OS for patients who progressed within 24 months (POD24T) was 60%, in comparison with 85% for patients without progression. Thus the benefit of rituximab maintenance after ASCT on relapse prevention is sustained at 12 years, suggesting that RM adds to ASCT-mediated disease eradication and may enhance the curative potential of ASCT.
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Affiliation(s)
- R Pettengell
- Institute of Medical & Biomedical Education, St George's University of London, London, United Kingdom.
| | - R Uddin
- EBMT Clinical Trials Office, European Society for Blood and Marrow Transplantation, London, United Kingdom
| | - A Boumendil
- Statistics, European Society for Blood and Marrow Transplantation, Paris, France
| | - R Johnson
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - B Metzner
- University Clinic for Internal Medicine, Oncology and Haematology, Klinikum Oldenburg, Oldenburg, Germany
| | - A Martín
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - J Romejko-Jarosinska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw, Poland
| | | | - P Giri
- Haematology, Royal Adelaide Hospital, Adelaide, Southern Australia, Australia
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - S P Robinson
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - E Kimby
- Department of Hematology, Karolinska Institute, Stockholm, Sweden
| | - N Schmitz
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A H Goldstone
- University College London Hospital, London, United Kingdom
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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3
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Song J, Samant R, Fan X, Jay M, Chaudry H, MacDonald D, Bence-Bruckler I, Nair V. EP-1221 Palliative cranial irradiation improves survival in PCNSL patients ineligible for systemic therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Rule S, Jurczak W, Jerkeman M, Rusconi C, Trneny M, Offner F, Caballero D, Joao C, Witzens-Harig M, Hess G, Bence-Bruckler I, Cho SG, Thieblemont C, Zhou W, Henninger T, Goldberg J, Vermeulen J, Dreyling M. Ibrutinib versus temsirolimus: 3-year follow-up of patients with previously treated mantle cell lymphoma from the phase 3, international, randomized, open-label RAY study. Leukemia 2018; 32:1799-1803. [PMID: 29572505 PMCID: PMC6087720 DOI: 10.1038/s41375-018-0023-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 11/23/2022]
Affiliation(s)
- S Rule
- Plymouth University Medical School, Plymouth, UK.
| | - W Jurczak
- Department of Hematology, Jagiellonian University, Krakow, Poland
| | - M Jerkeman
- Skånes University Hospital, Lund University, Lund, Sweden
| | - C Rusconi
- Hematology Division, Hematology and Oncology Department, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - M Trneny
- Ist Dept Medicine, Charles University General Hospital, Prague, Czech Republic
| | - F Offner
- Departement Oncologie, UZ Gent, Ghent, Belgium
| | - D Caballero
- Instituto Biosanitario de Salamanca, Hospital Clinico Universitario Salamanca, Salamanca, Spain
| | - C Joao
- Institutto Português de Oncologia de Lisboa, Portugal and Champalimaud Centre for the Unknown, Hematology, Lisbon, Portugal
| | - M Witzens-Harig
- Klinikum der Ruprechts-Karls-Universität Heidelberg, Med. Klinik u. Poliklinik V, Heidelberg, Germany
| | - G Hess
- Department of Hematology, Oncology and Pneumology, University Medical School of the Johannes Gutenberg University, Mainz, Germany
| | | | - S-G Cho
- Seoul St. Mary's Hospital, Seocho-gu, Seoul, South Korea
| | - C Thieblemont
- APHP, Saint-Louis Hospital, Hemato-oncology, Diderot University, Paris, France
| | - W Zhou
- Janssen Research & Development, Raritan, NJ, USA
| | - T Henninger
- Janssen Research & Development, Raritan, NJ, USA
| | - J Goldberg
- Janssen Research & Development, Raritan, NJ, USA
| | - J Vermeulen
- Janssen Research & Development, Leiden, The Netherlands
| | - M Dreyling
- Department of Medicine III, Klinikum der Universität München, LMU, Munich, Germany
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5
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Klanova M, Sehn L, Bence-Bruckler I, Cavallo F, Jin J, Martelli M, Stewart D, Vitolo U, Zaja F, Zhang Q, Mattiello F, Oestergaard M, Fingerle-Rowson G, Nielsen T, Trneny M. CELL OF ORIGIN COMBINED WITH CNS INTERNATIONAL PROGNOSTIC INDEX IMPROVES IDENTIFICATION OF DLBCL PATIENTS WITH HIGH CNS RELAPSE RISK AFTER INITIAL IMMUNOCHEMOTHERAPY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Klanova
- 1st Department of Medicine, Charles University General Hospital; Prague, Czech Republic and Pharma Development Clinical Oncology, F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - L.H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver Canada
| | - I. Bence-Bruckler
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa Canada
| | - F. Cavallo
- Ematologia 1; A.O. Universitaria S. Giovanni Battista-Molinette Di Torino; Torino Italy
| | - J. Jin
- The First Affiliated Hospital of College of Medicine; Zhejiang University; Wenzhou China
| | - M. Martelli
- Department of Cellular Biotechnologies and Hematology; Sapienza University; Rome Italy
| | - D. Stewart
- Department of Oncology; Tom Baker Cancer Centre; Calgary Canada
| | - U. Vitolo
- S.C. Ematologia; A.O.U. Citta' Della Salute e della Scienza P.O. Molinette; Turino Italy
| | - F. Zaja
- Oncologia; Clinica Ematologica, ASUI UD S.M. Misericordia di Udine; Udine Italy
| | - Q. Zhang
- Department of Medical Oncology; Harbin Medical University Cancer Hospital; Harbin China
| | - F. Mattiello
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M.Z. Oestergaard
- Oncology Biomarker Development; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - G.R. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M. Trneny
- 1st Department of Medicine; Charles University General Hospital; Prague Czech Republic
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6
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Pettengell R, Uddin R, Boumendil A, Robinson S, Smith G, Hawkins T, Metzner B, Caballero M, Tilly H, Romejko-Jarosinska J, Bence-Bruckler I, To B, Niemann C, Kimby E, Dreger P, Schmitz N, Goldstone A, Montoto S. DURABLE BENEFIT OF RITUXIMAB MAINTENANCE POST-AUTOGRAFT IN PATIENTS WITH RELAPSED FOLLICULAR LYMPHOMA: 12-YEAR FOLLOW-UP OF THE EBMT LYMPHOMA WORKING PARTY LYM1 TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R. Pettengell
- Institute of Medical & Biomedical Education; St George's University of London; London UK
| | - R. Uddin
- EBMT Clinical Trials Office; European Society for Blood and Marrow Transplantation; London UK
| | - A. Boumendil
- Statistics; European Society for Blood and Marrow Transplantation; Paris France
| | - S.P. Robinson
- Department of Haematology; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - G. Smith
- Department of Haematology; St James's Hospital; Leeds UK
| | - T. Hawkins
- Haematology; Auckland City Hospital; Auckland New Zealand
| | - B. Metzner
- University Clinic for Internal Medicine; Oncology and Haematology, Klinikum Oldenburg; Oldenburg Germany
| | - M.D. Caballero
- Hematology Department, Hospital Universitario de Salamanca; Instituto Biosanitario, IBSAL; Salamanca Spain
| | - H. Tilly
- Haematology; Centre Henri Becquerel; Rouen France
| | - J. Romejko-Jarosinska
- Department of Lymphoproliferative Diseases; Maria Sklodowska-Curie Memorial Institute and Oncology Center; Warsaw Poland
| | | | - B. To
- Haematology; Royal Adelaide Hospital; Adelaide Australia
| | - C. Niemann
- Hematology; Rigshospitalet; Copenhagen Denmark
| | - E. Kimby
- Dept of Hematology; Karolinska Institute; Stockholm Sweden
| | - P. Dreger
- Hematology; University of Heidelberg; Heidelberg Germany
| | - N. Schmitz
- Hematology; Asklepios Hospital St Georg; Hamburg Germany
| | - A.H. Goldstone
- North London Cancer Network; Univ. College London Hospital; London UK
| | - S. Montoto
- Dept. of Haematology; Queen Mary University of London; London UK
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7
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Rule S, Jurczak W, Jerkeman M, Santucci Silva R, Rusconi C, Trneny M, Offner F, Caballero D, Joao C, Witzens-Harig M, Hess G, Bence-Bruckler I, Cho S, Thieblemont C, Zhou W, Henninger T, Goldberg J, Vermeulen J, Dreyling M. IBRUTINIB VS TEMSIROLIMUS: THREE-YEAR FOLLOW-UP OF PATIENTS WITH PREVIOUSLY TREATED MANTLE CELL LYMPHOMA FROM THE PHASE 3, INTERNATIONAL, RANDOMIZED, OPEN-LABEL RAY STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Rule
- Haematology; Derriford Hospital; Plymouth UK
| | - W. Jurczak
- Hematology; Jagiellonian University; Krakow Poland
| | - M. Jerkeman
- Oncology; Skånes University Hospital; Lund Sweden
| | - R. Santucci Silva
- Oncology; Instituto de Ensino e Pesquisa Sao Lucas; Sao Paulo Brazil
| | - C. Rusconi
- Hematology and Oncology; Niguarda Hospital; Milan Italy
| | - M. Trneny
- First Department Medicine; Charles University General Hospital; Prague Czech Republic
| | | | - D. Caballero
- Hematology; Hospital Clinico Universitario Salamanca; Salamanca Spain
| | - C. Joao
- Oncology; Institutto Português de Oncologia de Lisboa; Lisbon Portugal
| | | | - G. Hess
- Hematology, Oncology and Pneumology; University Medical School of the Johannes Gutenberg University; Mainz Germany
| | | | - S. Cho
- Hematology; Seoul St. Mary's Hospital; Seoul Republic of Korea
| | | | - W. Zhou
- Oncology; Janssen Research & Development; Raritan USA
| | - T. Henninger
- Oncology; Janssen Research & Development; Raritan USA
| | - J.D. Goldberg
- Oncology; Janssen Research & Development; Raritan USA
| | - J. Vermeulen
- Oncology; Janssen Research & Development; Beerse Belgium
| | - M. Dreyling
- Medicine III; Klinikum der Universität München, LMU; Munich Germany
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8
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Takach S, Yang L, Ho J, Sabri E, Martin L, Halpenny M, Atkins H, Sabloff M, McDiarmid SA, Huebsch LB, Bence-Bruckler I, Giulivi A, Allan DS. Monoclonal B cells detected in autologous PBSC grafts from patients with classical Hodgkin lymphoma: impact on relapse and survival following transplantation. Bone Marrow Transplant 2009; 45:856-61. [PMID: 19767777 DOI: 10.1038/bmt.2009.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autologous peripheral blood stem cell transplantation (PBSCT) for Hodgkin lymphoma (HL) is curative for many patients with relapsed or refractory disease. Relapsing disease, however, remains a major problem. Neoplastic transformation of B-lymphocytes probably underlies the development of classical HL. Whether clonal B cells are critical for disease evolution and response to therapy in HL remains uncertain. We investigated the impact of clonal B cells detected in peripheral blood stem cell (PBSC) collections on the outcome of patients with HL undergoing transplant. Qualitative semi-nested PCR was carried out on genomic DNA from mononuclear cells from PBSCs to determine the presence of clonal immunoglobulin heavy chain (IgH) complementary-determining region 3 (CDR3) gene rearrangements. Clinical factors were assessed for their association with relapse, overall survival (OS) and progression-free survival (PFS). Among 39 patients undergoing PBSCT, 12 grafts (31%) were PCR positive for clonal IgH rearrangements. OS was better in the PCR-negative group (logrank test, P=0.041). The OS at 5 years was 81% in PCR-negative versus 39% in PCR-positive patients; hazard ratio was 3.23 (95% confidence interval: 0.98-10.63). There was a trend towards better PFS (logrank test, P=0.12), estimated as 71% at 5 years in PCR-negative versus 41% in PCR-positive patients. Clonal B-lymphocytes in PBSC collections of patients with HL identify patients at risk of poor outcome. Larger series are needed to confirm our observations. Insight regarding the role of monoclonal B cells may lead to improved therapies.
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Affiliation(s)
- S Takach
- Division of Hematology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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9
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Singh R, Samant R, Alomary I, Alsaeed E, Al-jasir B, Bence-Bruckler I, Cross P, Huebsch L, Genest P. 18 PATTERNS OF RELAPSE AMONG EARLY STAGE HODGKIN'S LYMPHOMA PATIENTS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Ho J, Yang L, Banihashemi B, Martin L, Halpenny M, Atkins H, Sabloff M, McDiarmid SA, Huebsch LB, Bence-Bruckler I, Giulivi A, Allan DS. Contaminating tumour cells in autologous PBSC grafts do not influence survival or relapse following transplant for multiple myeloma or B-cell non-Hodgkin's lymphoma. Bone Marrow Transplant 2008; 43:223-8. [DOI: 10.1038/bmt.2008.318] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Sabloff M, McDiarmid S, Atkins H, Bence-Bruckler I, Bredeson C, Hopkins H, Genest P, Perry G, Huebsch L. A 15-year review of autologous stem cell transplant of advanced relapsed follicular lymphoma at the Ottawa hospital. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Alsaeed E, Samant R, Gallant V, Genest P, Cross P, Kendall W, Bence-Bruckler I, Huebsch L. 224 Contemporary approaches to the management of early stage Hodgkin's lymphoma. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Sabloff M, McDiarmid S, Bence-Bruckler I, Atkins H, Bredeson C, Hopkins H, Genest P, Perry G, Huebsch L. 73 The ottawa 10-year experience in allogeneic stem cell transplantation for follicular lymphoma. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Atkins H, Freedman M, Bowman M, Antel J, Arnold D, Bence-Bruckler I, Bar-Or A, Chen J, Cheynier R, Corsini R, Duquette P, Halpenny M, Huebsch L, Laneuville P, Lapierre Y, Messner H, O'Connor P, Sabloff M, Sekaly R. 148Immunoablative therapy with purified autologous stem cells rescue for the treatment of poor prognosis MS. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80149-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Bredeson C, Perry G, Martens C, McDiarmid S, Bence-Bruckler I, Atkins H, Serna D, Hopkins H, Mikhael J, Genest P, Huebsch L. Outpatient total body irradiation as a component of a comprehensive outpatient transplant program. Bone Marrow Transplant 2002; 29:667-71. [PMID: 12180111 DOI: 10.1038/sj.bmt.1703516] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Outpatient total body irradiation (TBI) as part of a comprehensive outpatient transplant program was delivered to 142 of 167 (85%) consecutive patients receiving TBI-based conditioning therapy. Outpatients received either a single fraction of 500 cGy (110 patients) or 1200 cGy in six fractions over 3 days (32 patients). Patients were assessed daily and were administered oral ondansetron and dexamethasone for prophylaxis of nausea and vomiting as well as i.v. hydration. Accommodation during outpatient TBI-based conditioning was either the patient's home if within 30 min of the hospital, a hotel on the hospital grounds or on a closed hospital ward. None of the 142 patients required admission to the inpatient program during their TBI. There was no difference in 100-day mortality between those receiving TBI as an outpatient (9%) vs as an inpatient (16%). Of four deaths occurring within the first 14 days post transplant, none could be attributed to receiving TBI as an outpatient. Two hundred and six inpatient days were saved through the delivery of outpatient TBI. A comprehensive outpatient program, appropriate patient selection, daily hydration, the use of prophylactic 5HT3 antagonist anti-emetic therapy all contribute to the safe delivery of outpatient TBI.
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Affiliation(s)
- C Bredeson
- IBMTR/ABMTR Statistical Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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16
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Perry G, Donker R, Dahrouge S, Genest P, Bence-Bruckler I, Atkins H, Bredeson C, Huebsch L. Total body irradiation (TBI) with stem cell transplantation (SCT) in multiple myeloma (MM). Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Fields KK, Crump M, Bence-Bruckler I, Bernstein S, Williams S, Frankel S, Miller A, Demetri G, Nabholtz JM, Cruickshank S, Lill M. Use of PEG-rHuMGDF in platelet engraftment after autologous stem cell transplantation. Bone Marrow Transplant 2000; 26:1083-8. [PMID: 11108307 DOI: 10.1038/sj.bmt.1702662] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper summarizes a pilot, sequential dose-escalation study of PEG-rHuMGDF in patients with advanced malignancies who had delayed platelet recovery after autologous stem cell transplantation (ASCT). Patients were randomized to receive either placebo (n = 11) or PEG-rHuMGDF at 5 (n = 9), 10 (n = 6), or 25 (n = 7) microg/kg/day by subcutaneous injection for 14 days and were monitored for 5 weeks. Across all treatment groups, eight patients had platelet recovery to > or = 20 x 10(9)/l by day 21. The proportion of patients achieving platelet recovery, the median number of days and units of platelet transfusions were similar for the placebo and the PEG-rHuMGDF groups. PEG-rHuMGDF was well tolerated at all dosages. The incidence rates of adverse events in all groups were similar. No deaths on study, no drug-related serious adverse events, and no development of neutralizing antibodies to MGDF occurred.
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Affiliation(s)
- K K Fields
- H Lee Moffitt Cancer Center, Tampa, FL 33617, USA
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18
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Leger CS, Bredeson C, Kearns B, Bence-Bruckler I, Atkins H, Huebsch L. Autologous blood and marrow transplantation in patients 60 years and older. Biol Blood Marrow Transplant 2000; 6:204-10. [PMID: 10816029 DOI: 10.1016/s1083-8791(00)70044-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although many hematologic malignancies are more common in older patients, autologous blood and marrow transplantation (ABMT) has traditionally been restricted to patients younger than 60 years because of concerns that older patients would be either unable to provide a graft or unable to tolerate the therapy. From June 1995 to May 1998, 30 patients > or = 60 years underwent ABMT at our institution for low-grade lymphoma (4 patients), relapsed intermediate-grade lymphoma (17 patients), or multiple myeloma (9 patients). The median patient age was 62.5 years (range 60-73). Pretransplantation conditioning regimens were CBV (cyclophosphamide, BCNU [carmustine], etoposide) or BEAM (carmustine, etoposide, cytarabine, melphalan) for intermediate-grade lymphoma patients and melphalan 140 mg/m2 + etoposide 60 mg/kg + total body irradiation 500 cGy for the others. The rescue product was bone marrow (BM; 4 patients), peripheral blood stem cells (PBSC; 23 patients), or BM+PBSC (3 patients). The median number of CD34+ cells/kg infused was 3.60 x 10(6) (range 0.53-31.0), by the International Society for Hematotherapy and Graft Engineering method. The treatment-related mortality at day 100 and at 6 months was 10% and 16.7%, respectively. The median days to neutrophil > 0.5 x 10(9)/L was 11 (range 9-25) and platelets > 20 x 10(9)/L was 16 (range 6-70). Three patients died of infection (days 26, 27, and 38), and 1 died of an intracranial hemorrhage related to persistent thrombocytopenia (day 130). Bearman regimen-related toxicity was moderate, with most toxicities < or = grade 2. Seven patients developed significant gut toxicity: 4 patients with Clostridium difficile colitis and 3 patients with neutropenic enterocolitis. Depressive symptoms and signs were noted in 4 patients. Three male patients developed decreased gonadal function after transplantation. These transplantations accounted for 997 patient days, of which 266 days (27%) were in the outpatient BMT program--a smaller percentage than in patients < 60 years (56%, P = .002). Twenty patients are alive 153 to > or = 1224 days after transplantation. ABMT in patients > or = 60 years of age is feasible. Further studies addressing supportive care particular to older patients and comparisons of ABMT with traditional approaches to multiple myeloma and relapsed non-Hodgkin's lymphoma in older patients are needed. Further work to identify elderly patients most likely to benefit from this approach is also required.
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Affiliation(s)
- C S Leger
- Blood and Marrow Transplantation Programme, University of Ottawa, Ontario, Canada
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19
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Rajcan-Separovic E, Bence-Bruckler I, Wells P, Wang H. Fluorescence in situ hybridization analysis of complex translocations in two newly diagnosed Philadelphia chromosome-positive chronic myelogenous leukemia patients. Cancer Genet Cytogenet 1999; 114:71-4. [PMID: 10526539 DOI: 10.1016/s0165-4608(99)00047-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two different complex translocations from newly diagnosed cases of Philadelphia chromosome-positive chronic myelogenous leukemia (CML) were characterized by G-banding and fluorescence in situ hybridization (FISH) analysis. In one case, a unique balanced t(9;22;9;11) (q34;q11;p22;q23) was identified by G-banding, and confirmed by FISH using MBCR/ABL and painting probes. In the second case, an apparently balanced t(19;22) was identified by G-banding analysis. FISH using MBCR/ABL probe detected the fusion gene on the derivative chromosome 22, indicating the involvement of chromosome 9. Further FISH analysis with selected painting probes showed that the t(19;22) was a result of a complex translocation involving chromosomes 9, 19, 21, and 22.
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MESH Headings
- Adult
- Aged
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 9
- Humans
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Translocation, Genetic
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20
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Bence-Bruckler I, Bredeson C, Atkins H, McDiarmid S, Hamelin L, Hopkins H, Perry G, Genest P, Huebsch L. A randomized trial of granulocyte colony-stimulating factor (Neupogen) starting day 1 vs day 7 post-autologous stem cell transplantation. Bone Marrow Transplant 1998; 22:965-9. [PMID: 9849693 DOI: 10.1038/sj.bmt.1701469] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the study was to evaluate the effect of delayed granulocyte colony-stimulating factor (G-CSF) use on hematopoietic recovery post-autologous peripheral blood progenitor cell (PBPC) transplantation. Patients were randomized to begin G-CSF on day +1 or day +7 post transplantation. Thirty-seven patients with lymphoma or myeloma undergoing high-dose therapy and autologous PBPC rescue were randomized to daily subcutaneous G-CSF beginning on day +1 or day +7 post-transplant. Patients < or =70 kg received 300 microg/day and >70 kg 480 microg/day. All patients were reinfused with PBPCs with a CD34+ cell count >2.0 x 10(6)/kg. Baseline characteristics of age, sex and CD34+ cell count were similar between the two arms, the median CD34+ cell count being 5.87 x 10(6)/kg in the day +1 group and 7.70 x 10(6)/kg in the day +7 group (P=0.7). The median time to reach a neutrophil count of >0.5 x 10(9)/l was 9 days in the day +1 arm and 10 days in the day +7 arm, a difference which was not statistically significant (P=0.68). Similarly, there was no difference in median days to platelet recovery >20000 x 10(9)/l, which was 10 days in the day +1 arm and 11 days in the day +7 arm (P=0.83). There was also no significant difference in the median duration of febrile neutropenia (4 vs 6 days; P=0.7), intravenous antibiotic use (7 vs 8 days; P=0.54) or median number of red blood cell transfusions (4 vs 7 units; P=0.82) between the two arms. Median length of hospital stay was 11 days post-PBPC reinfusion in both groups. The median number of G-CSF injections used was 8 in the day +1 group and 3 in the day +7 group (P < 0.0001). There is no significant difference in time to neutrophil or platelet recovery when G-CSF is initiated on day +7 compared to day +1 post-autologous PBPC transplantation. There is also no difference in number of febrile neutropenic or antibiotic days, number of red blood cell transfusions or length of hospital stay. The number of doses of G-CSF used per transplant is significantly reduced with delayed initiation, resulting in a significant reduction in drug costs. For patients with an adequately mobilized PBPC graft, the initiation of G-CSF can be delayed until day +7 post-PBPC reinfusion.
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Affiliation(s)
- I Bence-Bruckler
- Ottawa General Hospital Blood and Marrow Transplantation Programme, University of Ottawa, Ontario, Canada
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21
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Berinstein NL, Grillo-López AJ, White CA, Bence-Bruckler I, Maloney D, Czuczman M, Green D, Rosenberg J, McLaughlin P, Shen D. Association of serum Rituximab (IDEC-C2B8) concentration and anti-tumor response in the treatment of recurrent low-grade or follicular non-Hodgkin's lymphoma. Ann Oncol 1998; 9:995-1001. [PMID: 9818074 DOI: 10.1023/a:1008416911099] [Citation(s) in RCA: 402] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Monoclonal antibodies are being utilized for treatment of patients with low-grade non-Hodgkin's lymphoma as well as other cancers. Results from phase I and II clinical studies has shown that the chimeric monoclonal antibody Rituximab has minimal toxicity and significant therapeutic activity in low grade non-Hodgkin's lymphoma. PATIENTS AND METHODS We have recently reported on a multicentre pivotal phase III clinical trial involving 166 patients with recurrent low-grade lymphoma who were treated with four infusions of Rituximab. Eighty patients (48%) achieved objective responses including 10 patients (6%) with complete responses. Overall, 126 patients (76%) had a > or = 20% reduction in overall tumor size. The median response duration and time to progression are 11.6 and 13.2 months, respectively. The infusional and long term toxicities were limited. RESULTS In this report we describe the pharmacokinetic data obtained on these patients. Measurable concentrations of Rituximab were detected in all patients after the first infusion and increased throughout the treatment course. The half-life of the monoclonal antibody increased from 76.3 hours after the first infusion to 205.8 hours after the fourth infusion and was concomitant with a four-fold decrease in the antibody clearance. At three months and six months post-treatment, the median Rituximab serum levels were 20.3 micrograms/ml (range 0.0 to 96.8 micrograms/ml in 104 patients) and 1.3 micrograms/ml (range 0.0-28.7 micrograms/ml in 13 patients), respectively. A statistically significant correlation was found between the median antibody concentration and response for multiple time points during the treatment and followup. The mean serum antibody concentration was also inversely correlated with measurements of tumor bulk and with the number of circulating B cells at baseline. CONCLUSIONS We conclude that Rituximab is therapeutically effective against B-cell lymphoma. Pharmacokinetic data suggests that certain subsets of patients may possibly benefit from increased dosing and studies to address this are currently underway.
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MESH Headings
- Antibodies, Monoclonal/blood
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/blood
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Agents/therapeutic use
- Half-Life
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/metabolism
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/metabolism
- Neoplasm Recurrence, Local
- Rituximab
- Treatment Outcome
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Affiliation(s)
- N L Berinstein
- Department of Medicine, Toronto-Sunnybrook Regional Cancer Centre, Ontario, Canada.
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22
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McLaughlin P, Grillo-López AJ, Link BK, Levy R, Czuczman MS, Williams ME, Heyman MR, Bence-Bruckler I, White CA, Cabanillas F, Jain V, Ho AD, Lister J, Wey K, Shen D, Dallaire BK. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol 1998; 16:2825-33. [PMID: 9704735 DOI: 10.1200/jco.1998.16.8.2825] [Citation(s) in RCA: 1956] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The CD20 antigen is expressed on more than 90% of B-cell lymphomas. It is appealing for targeted therapy, because it does not shed or modulate. A chimeric monoclonal antibody more effectively mediates host effector functions and is itself less immunogenic than are murine antibodies. PATIENTS AND METHODS This was a multiinstitutional trial of the chimeric anti-CD20 antibody, IDEC-C2B8. Patients with relapsed low grade or follicular lymphoma received an outpatient treatment course of IDEC-C2B8 375 mg/m2 intravenously weekly for four doses. RESULTS From 31 centers, 166 patients were entered. Of this intent-to-treat group, 48% responded. With a median follow-up duration of 11.8 months, the projected median time to progression for responders is 13.0 months. Serum antibody levels were sustained longer after the fourth infusion than after the first, and were higher in responders and in patients with lower tumor burden. The majority of adverse events occurred during the first infusion and were grade 1 or 2; fever and chills were the most common events. Only 12% of patients had grade 3 and 3% grade 4 toxicities. A human antichimeric antibody was detected in only one patient. CONCLUSION The response rate of 48% with IDEC-C2B8 is comparable to results with single-agent cytotoxic chemotherapy. Toxicity was mild. Attention needs to be paid to the rate of antibody infusion, with titration according to toxicity. Further investigation of this agent is warranted, including its use in conjunction with standard chemotherapy.
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Affiliation(s)
- P McLaughlin
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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23
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Bredeson C, Malcolm J, Davis M, Bence-Bruckler I, Kearns B, Huebsch L. Cost analysis of the introduction of PBPC for autologous transplantation: effect of switching from bone marrow (BM) to peripheral blood progenitor cells (PBPC). Bone Marrow Transplant 1997; 20:889-96. [PMID: 9404932 DOI: 10.1038/sj.bmt.1700977] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Increasingly, PBPC instead of BM are used for autologous transplantation. Limited data exist on the economic effects of this change. Using a resource-based utilization model we prospectively determined the costs of 48 autologous transplants (eight BM, 17 BM + PBPC, 23 PBPC), isolating the post-reinfusion period (day 0 to discharge) to better determine the effect of the rescue product. Length of stay post-reinfusion was significantly shorter in patients receiving PBPC (median 13 days) or BM + PBPC (median 14 days) vs BM alone (median 20 days) (P < 0.01). Accordingly, transplant admission costs were less in the PBPC groups (PBPC $22089, BM + PBPC $23179) vs the BM alone group ($32289) (P < 0.05). Rescue product acquisition costs were higher for PBPC (range $3439-$5157) vs BM ($2766) but these costs were offset by the more rapid recovery of patients receiving PBPC. Overall transplant costs depend on the conditioning regimen with a 10-fold cost variation among regimens. Modeled costs for autologus transplantation using various approaches to rescue product acquisition are given. The introduction of PBPC for autologus transplantation has resulted in cost savings at our institution. Although the acquisition costs of PBPC rescue product are greater than for BM, this incremental expense is more than offset by a less expensive post-reinfusion period.
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Affiliation(s)
- C Bredeson
- Division of Hematology, Ottawa General Hospital, Ontario, Canada
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