1
|
Muntañola A, Baumann T, Caballero AC, Sánchez-González B, Mercadal S, Escoda L, Soler A, Iserte L, Canet M, Villalobos MT, Magnano L, Sorigué M, García O, Salar A, López-Guillermo A, Sancho JM. Results of R-ESHAP as salvage therapy in refractory/relapsed follicular lymphoma: a real-world experience on behalf of GELCAB group. Ann Hematol 2020; 99:1627-34. [PMID: 32451707 DOI: 10.1007/s00277-020-04101-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022]
Abstract
There is no standard treatment for relapsed follicular lymphoma (FL). Although platinum-based combinations are one of the most used treatments, few data have been reported in this setting. Our aim was to analyse R-ESHAP efficacy in relapsed FL patients. We retrospectively analysed 80 FL patients treated with R-ESHAP in the first or successive relapses. Responding patients received a stem cell transplantation following R-ESHAP. Seventeen histologically transformed patients were included. Median age was 50 years. At R-ESHAP initiation, 85% of the patients were in an advanced stage, 28% had a bulky disease and 40% had increased LDH. There were no statistically significant differences between POD24 and non-POD24 patients in terms of response to R-ESHAP (ORR 72% vs. 93%, p = 0.109). When analyzing R-ESHAP efficacy according to the response to the immediately previous line, patients achieving CR or PR had better CR rates to R-ESHAP than those who did not respond (CR of 57% vs. 15%, respectively, p = 0.009), as well as differences in OS (7.2 vs. 1.4 years, p < 0.0001) and in PFS (2.1 vs. 0.3 years, p < 0.0001). R-ESHAP is an effective treatment in relapsed FL patients who respond to the previous line and has to be considered as an adequate alternative for some patients.
Collapse
|
2
|
Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Trend of salvage treatment in diffuse large B cell lymphoma in the outpatient chemotherapy era. Mol Clin Oncol 2019; 11:557-562. [PMID: 31692990 PMCID: PMC6826265 DOI: 10.3892/mco.2019.1930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/20/2019] [Indexed: 12/03/2022] Open
Abstract
Patients with diffuse large B cell lymphoma (DLBCL) who have failed to achieve complete remission with first-line therapy can subsequently receive salvage therapy. However, there is no definite consensus on the use of salvage therapy, and little information on the optimal treatment regimen. The present study retrospectively analyzed data from 131 patients diagnosed with DLBCL between April 2002 and November 2017 who relapsed and received salvage therapy. Primary treatment included R-CHOP or R-CHOP-like regimens. The most common salvage regimen was R-DeVIC (42%), followed by R-ESHAP (23%), other aggressive regimens (12%) and palliative therapy (23%). The median overall survival (OS) was 45.7 months for R-DeVIC, 41.8 months for palliative therapy, 29.4 months for R-ESHAP, and 28.5 months for aggressive regimens (P=0.937). A total of 25 patients underwent autologous stem cell transplantation (ASCT), and the OS was 75.6 months for these patients compared with 33.5 months (range, 25.6–45.6 months) for patients who did not undergo ASCT (P=0.033). Following the establishment of an outpatient chemotherapy unit in 2014, R-DeVIC use became more common, increasing from 37% prior to 2014 to 46% after 2014, whereas R-ESHAP use decreased (31 to 17%). The present study did not identify the optimal salvage regimen for patients with DLBCL. However, salvage ASCT improved the outcome, and regimens administered via peripheral veins were demonstrated to be more common in outpatient chemotherapy settings.
Collapse
Affiliation(s)
- Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Yoshiko Azuma
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Yukie Tsubokura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Ryo Saito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Akiko Konishi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| |
Collapse
|
3
|
Montoro J, Andreola G, Gardellini A, Babic A, Negri M, Frungillo N, Martinelli G, Laszlo D. R-ESHAP plus pegfilgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory diffuse large B-cell lymphoma. Transfus Apher Sci 2014; 50:411-4. [PMID: 24751603 DOI: 10.1016/j.transci.2014.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/24/2014] [Indexed: 11/30/2022]
Abstract
Stem cell (SC) mobilization is significantly influenced by the mobilization schedule in patients with lymphoma. We evaluated data from 30 patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) undergoing SC mobilization. All received R-ESHAP plus a single dose of pegfilgrastim. All patients collected ⩾ 2 × 10(6) CD34+cells/kg, 80% of them at least 5 × 10(6) CD34+cells/kg. Adverse effects of the regimen included myelosuppression and neutropenic fever. Herein, our results suggest that R-ESHAP plus pegfilgrastim is a highly effective mobilization strategy in patients affected by DLBCL associated with a low incidence of adverse events.
Collapse
Affiliation(s)
- Juan Montoro
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - Giovanna Andreola
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Angelo Gardellini
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Aleksandra Babic
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Mara Negri
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Niccolò Frungillo
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Giovanni Martinelli
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Daniele Laszlo
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| |
Collapse
|