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Kumar S, Sharma A, Bakhshi S, Pushpam D, Gogia A, Sahoo RK, Pramanik R, Kumar A, Pathak N, Thulkar S, Sharma MC, Gupta R, Mallick S, Raina V. Autologous Stem Cell Transplantation in Adult Hodgkin Lymphoma at a Tertiary Care Center in India: Analysis of Outcomes and Prognostic Factors. Indian J Hematol Blood Transfus 2024; 40:181-189. [PMID: 38708163 PMCID: PMC11065798 DOI: 10.1007/s12288-023-01690-x] [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: 04/25/2023] [Accepted: 08/10/2023] [Indexed: 05/07/2024] Open
Abstract
High-dose chemotherapy and autologous stem cell transplant (ASCT) is the standard of care treatment in relapsed/refractory Hodgkin lymphoma (rrHL). Published long-term follow-up data concerning this modality from the Indian subcontinent is lacking. In this retrospective study, the data on adults (> 16 years) with biopsy-confirmed rrHL who were autografted from 1 January 2000 to 31 December 2021 at our transplant unit were analyzed. Progression-free survival (PFS) was defined as time from transplant to disease progression or death due to any cause. Overall survival (OS) was determined from date of transplant to date of death due to any cause. Overall, 134 patients with Hodgkin lymphoma underwent ASCT. At a median follow-up of 38.2 (range, 0.1-240) months, 5 years PFS was 45.3% (95% CI 35.4-54.4). The probability of OS at 5 years was 60.5% (95% CI 49.6-69.6). Eleven (8.2%) patients suffered transplant-related mortality by 100 days. Post-transplant persistent disease, pre-transplant serum hypoalbuminemia (< 3.5 g/dl) and chemo-resistance (< PR after last salvage regimen) of tumour at transplant were independent prognostic factors associated with worse PFS in multivariable analysis. Likewise, age ≥ 30 years, ECOG performance status ≥ 1 and residual disease after transplantation correlated with inferior OS. Long-term outcomes of rrHL patients undergoing ASCT in India match those from the developed world in the era of peripheral blood stem cell transplantation. Pre-transplant performance status, chemo-sensitivity of disease, serum albumin and post-transplant remission status determined survival in our cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01690-x.
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Affiliation(s)
- Sudhir Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Raja Pramanik
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Akash Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Neha Pathak
- Department of Medical Oncology, Institute of Liver and Biliary Sciences, New Delhi, 110070 India
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Meher Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ritu Gupta
- Department of Medical Oncology, Lab Oncology Unit, Dr BRA IRCH All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Vinod Raina
- Fortis Memorial Research Institute, Gurgaon, 122006 India
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Jindal N, C M, Mathew LJ, Kumbhalwar K, Patel K, Garg M, Mirgh S, Chichra A, Nayak L, Bonda A, Gokarn A, Punatar S, Bagal B, Khattry N. Fertility outcomes in patients desiring conception following autologous stem cell transplantation for hodgkin lymphoma using LACE conditioning. Bone Marrow Transplant 2024; 59:417-418. [PMID: 38102211 DOI: 10.1038/s41409-023-02179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Nishant Jindal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Muralidaran C
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Libin Jacob Mathew
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Komal Kumbhalwar
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Kaumil Patel
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Malini Garg
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Akanksha Chichra
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
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Vély A, Couturier MA, Delepine P, Le Calloch R, Ertault M, Gastinne T, Plichon C, Lebreton A, Lester MA, Larhantec G, Cormier N, Fouquet S, Houot R, Tanguy-Schmidt A, Hunault-Berger M, Orvain C. Comparison of efficacy and toxicity according to etoposide and cytarabine dosing in BEAM conditioning followed by autologous stem cell transplantation in Hodgkin lymphoma. Leuk Lymphoma 2023; 64:2178-2187. [PMID: 37615123 DOI: 10.1080/10428194.2023.2251073] [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: 05/04/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by autologous stem cell transplantation (ASCT) is a commonly used intensification regimen for patients with Hodgkin lymphoma. As etoposide and cytarabine dosing are not defined, we conducted a retrospective, multicenter study, to compare efficacy and toxicity in 130 patients with Hodgkin lymphoma receiving etoposide and cytarabine at either 200 mg/m2/d (n = 50), 400 mg/m2/d (n = 35), or etoposide 200 mg/m2/d and cytarabine 400 mg/m2/d (n = 45). Progression-free survival and overall survival were not associated with the intensity of conditioning. Increased conditioning intensity was associated with longer duration of thrombocytopenia, a higher number of transfused RBC and platelet units and a higher frequency of mucositis, but serious adverse events or infectious complications were not increased. The intensity of BEAM regimen was not associated with survival but with the rate of cytopenia and mucositis advocating for the use of lower dosing in frail patients.
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Affiliation(s)
- Agathe Vély
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
| | - Marie-Anne Couturier
- Service d'Hématologie Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | | | - Ronan Le Calloch
- Service d'Hématologie Clinique, Centre Hospitalier de Cornouaille, Quimper, France
| | - Marjan Ertault
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Gastinne
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Chloé Plichon
- Service de Pharmacie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Lebreton
- Service de Pharmacie, Centre Hospitalier Universitaire de Angers, Angers, France
| | | | - Gaelle Larhantec
- Service de Pharmacie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Nicolas Cormier
- Service de Pharmacie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Roch Houot
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Aline Tanguy-Schmidt
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
| | - Mathilde Hunault-Berger
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
| | - Corentin Orvain
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
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4
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Lin M, Wu X, Zhang L, Li L, Wang X, Fu X, Sun Z, Zhang X, Zhu L, Yu H, Chang Y, Nan F, Yan J, Zhou Z, Shi C, Zhang M, Li X. Fotemustine, etoposide, cytarabine, and cyclophosphamide (FEAC) conditioning regimen for autologous stem cell transplantation in lymphoma. Leuk Lymphoma 2023; 64:605-612. [PMID: 36657436 DOI: 10.1080/10428194.2023.2167492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To investigate the efficacy and safety of the FEAC (fotemustine, etoposide, cytarabine, and cyclophosphamide) conditioning regimen for the treatment of lymphoma, we retrospectively analyzed the records of 76 Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent autologous stem cell transplantation (ASCT) after the FEAC conditioning regimen. Their survival, as well as the clinical efficacy, hematopoietic engraftment time, and toxicity, were analyzed. One patient died of severe pulmonary infection, and the transplant-related mortality (TRM) was 1.3% (1/76). Hematopoietic engraftment was achieved successfully in the remaining 75 patients. The median times of neutrophil and platelet engraftment were 11 d (6-21 d) and 13 d (8-24 d), respectively. The 2-year progression-free survival (PFS) rate was 69.1%, and the 2-year overall survival (OS) rate was 84.2%. FEAC conditioning regimen has acceptable toxicity, and the prognosis of patients is good, making it a feasible alternative to the BEAM regimen for ASCT.
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Affiliation(s)
- Meng Lin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Linan Zhu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
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5
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Kumar S, Sharma A, Pramanik R, Pathak N, Gogia A, Kumar A, Kayal S, Sharma V, Sahoo RK, Thulkar S, Sharma MC, Gupta R, Mallick S, Thomas M, Raina V. Long-Term Outcomes and Safety Trends of Autologous Stem-Cell Transplantation in Non-Hodgkin Lymphoma: A Report From A Tertiary Care Center in India. JCO Glob Oncol 2022; 8:e2100383. [PMID: 35561291 PMCID: PMC9302266 DOI: 10.1200/go.21.00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Published experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.
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Affiliation(s)
- Sudhir Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pathak
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Medical Oncology, Lab Oncology Unit, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mercy Thomas
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Fortis Memorial Research Institute, Gurgaon, India
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6
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Zhang L, Yang H, Qian C, Zhou J, Zhu Q, Jiang Y, Liu S, Chen X, Xu T, Qu C, Li C, Jin Z, Chu J, Zhang X, Wu D, Huang H. Efficacy and toxicity of SEAM (semustine, etoposide, cytarabine, and melphalan) conditioning regimen followed by autologous stem cell transplantation in lymphoma. Hematology 2022; 27:404-411. [PMID: 35413224 DOI: 10.1080/16078454.2022.2051864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to evaluate the safety and efficacy of SEAM regimen followed by auto-SCT in lymphoma. PATIENTS AND METHODS We retrospectively reviewed the records of patients with lymphoma who underwent auto-SCT with SEAM conditioning regimen from January 2010 to June 2018 at our centre. In total, 97 patients were analysed. RESULTS The median time to neutrophil engraftment and platelet engraftment was 9.5 days (range, 7-15 days) and 12 days (range, 7-25 days), respectively. Grade 3-4 nausea/vomiting, mucositis and diarrhoea were observed in 21.6%, 36.1%, and 11.3% of patients, respectively. Treatment-related mortality at 100 days occurred in 2 patients (2.1%). After a median follow-up time of 53.9 months, the 3-year incidence of disease relapse or progression was 34%. The estimated progression-free survival and overall survival at 3 years were 62% and 75%, respectively. Compared with previous studies using BEAM as the conditioning regimen, this study shows that the SEAM regimen has a comparable efficacy and safety profile. CONCLUSIONS The SEAM regimen is feasible and might be an ideal alternative to BEAM regimen for lymphoma auto-SCT.
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Affiliation(s)
- Lihong Zhang
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,First Affiliated Hospital of Soochow University, Department of Ultrasound, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Haifei Yang
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Chongsheng Qian
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Jihao Zhou
- The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Department of Hematology, Shenzhen, Guangdong, People's Republic of China
| | - Qian Zhu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Yibin Jiang
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Shuo Liu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Xiaochen Chen
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Ting Xu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Changju Qu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Caixia Li
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Zhengming Jin
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China
| | - Jianhong Chu
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xinyou Zhang
- The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Department of Hematology, Shenzhen, Guangdong, People's Republic of China
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Haiwen Huang
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, Jiangsu, People's Republic of China.,Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of the Ministry of Health, Suzhou, Jiangsu, People's Republic of China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, People's Republic of China
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7
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Krishnamoorthi N, Prakash B, KM D, Pani CK, Ram M, Rajesh K, Dubashi B, Ganesan P, Kayal S. Outcome of CBV (Carmustine, Cyclophosphamide, Etoposide) Conditioning Regimen for Autologous Stem Cell Transplant in Lymphoma: A Retrospective Study from a Tertiary Cancer Center in South India. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0041-1740134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background In autologous stem cell transplant (ASCT) for lymphomas, no standard conditioning regimen has been defined so far. Thus, the choice is guided by the center's familiarity and experience with a particular regimen.
Objective To determine the response, toxicity, and survival outcomes in lymphoma patients who underwent ASCT with CBV (cyclophosphamide, carmustine, and etoposide) conditioning regimen.
Materials and Methods Between January 2013 and May 2019, 45 consecutive lymphoma patients who had ASCT with CBV conditioning regimen were included in this retrospective study. CBV consisted of cyclophosphamide (1.5 g/m2/day × 4 days), carmustine (300 mg/m2 × 1 day), and etoposide (125 mg/m2 twice daily × 3 days). Baseline characteristics, pre transplant response, apheresis, post-transplant toxicities, post-transplant response, and survival outcomes were collected. Endpoints were toxicity, response, event-free survival (EFS), and overall survival (OS).
Results The median age was 30 (range: 6–64) years. Diagnosis was Hodgkin lymphoma (HL) in 26 (58%) and non-Hodgkin lymphoma (NHL) in 19 (42%). Forty-three patients (95%) had chemosensitive disease; 22(49%) in CR, and 21 (46%) in PR. The median CD34 was 2.95 × 106/kg (range: 0.9–9.56). The median time to neutrophil engraftment was 11 days (9–23) and 13 (8–36) days for platelets. All patients had febrile neutropenia, clinically and/or microbiologically documented infection was seen in 75% of patients. The most common grade 3/4 toxicities were mucositis (n = 4, 9%), diarrhea (n = 4, 9%), and nausea/vomiting (n = 2, 4%). The average days of hospitalization was 18 (range: 10–37). Day 100 mortality was 6.6% (n = 3). The median follow-up was 44.8 months. The median EFS for the entire cohort was 23.8 months; for HL, the median EFS was not reached, and for NHL, it was 7.97 months (95% confidence interval [CI]: 1.57–14.37). The median OS for the entire cohort and for HL was not reached; for NHL, it was 24.3 months (95% CI: 0.56–48.11).
Conclusion CBV conditioning regimen was well tolerated with low grade 3/4 toxicities and efficacy comparable to literature data.
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Affiliation(s)
- Narendran Krishnamoorthi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Bhanu Prakash
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Dhanraju KM
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Chinmaya Kumar Pani
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Malliha Ram
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Kalpana Rajesh
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
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8
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Disease Status at Transplant has a Significant Impact on Outcomes of Autologous Transplantation (ASCT) in Patients with Hodgkin Lymphoma—A Single Center Experience. Indian J Hematol Blood Transfus 2021; 38:290-298. [PMID: 35496963 PMCID: PMC9001784 DOI: 10.1007/s12288-021-01450-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022] Open
Abstract
High dose chemotherapy followed by autologous stem cell transplantation is the treatment of choice for relapsed Hodgkin lymphoma (HL). We analyzed 100 consecutive patients who underwent ASCT at our center between January 1999 and June 2019 for relapsed or refractory disease with a median age of 28 years (range: 9-65). At ASCT, 59 were in complete remission (CR) while 31 achieved partial remission (PR) and 10 had refractory disease (RD). Most had BEAM conditioning with a median infused cell dose of 4.84 × 106 CD 34 cells/kg. Prompt engraftment occurred in 97 patients at a median of 11 days. The day 100 transplant related mortality (TRM) was 5%. At a median of 37 months follow up, 79 patients are alive while 34 have relapsed. The 3-year event free survival (EFS) and overall survival (OS) are 62.3 ± 0.5% and 77.9 ± 4.4% respectively. The 3-year OS for patients in CR, PR and RD were 83.0 ± 5.2%, 78.4 ± 8.1% and 38.9 ± 1.7 respectively [p = 0.007] while the 3-year EFS for CR, PR and RD were 73.1 ± 6.2%, 61.3 ± 9.2% and 25.0 ± 1.5 respectively [p = 0.005]. Only disease status at time of ASCT was found to correlate with both OS and EFS. ASCT for HL is associated with good outcomes and low TRM. Disease status at ASCT impacted both OS and EFS and strategies to improve outcomes in patients with refractory disease needs to be explored.
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9
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Colita A, Colita A, Bumbea H, Croitoru A, Orban C, Lipan LE, Craciun OG, Soare D, Ghimici C, Manolache R, Gelatu I, Vladareanu AM, Pasca S, Teodorescu P, Dima D, Lupu A, Coriu D, Tomuleasa C, Tanase A. LEAM vs. BEAM vs. CLV Conditioning Regimen for Autologous Stem Cell Transplantation in Malignant Lymphomas. Retrospective Comparison of Toxicity and Efficacy on 222 Patients in the First 100 Days After Transplant, On Behalf of the Romanian Society for Bone Marrow Transplantation. Front Oncol 2019; 9:892. [PMID: 31552193 PMCID: PMC6746965 DOI: 10.3389/fonc.2019.00892] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (ASCT) is widely used in patients with malignant lymphomas. In Europe over 8,000 ASCTs for lymphoma were performed out of a total of 40,000 transplants according to the European Bone Marrow Transplant (EBMT) activity survey in 2017. ASCT is considered the standard treatment for eligible patients failing to achieve remission after first line chemotherapy or patients with relapsed or refractory lymphomas, including classical Hodkin's lymphoma, diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma, as well as consolidation therapy in first remission in mantle cell lymphoma. BEAM (BCNU/carmustine, etoposide, cytarabine, and melphalan) is the most commonly used conditioning regimen for ASCT in patients with relapsed/refractory (R/R) lymphomas in Europe, whereas the CBV (cyclophosphamide, BCNU, and etoposide) regimen is also widely used in North America. Recently, concerns regarding BCNU toxicity as well as restricted availability of BCNU and melphalan has determined an increasing number of transplant centers to use alternative conditioning regimens. Currently, only a few comparative studies, most of them retrospective, between different conditioning protocols regarding efficacy and toxicity have been published. Thus, in the current manuscript, we report the experience of 2 transplant centers in ASCT in R/R lymphomas with three types of conditioning: BEAM, CLV (cyclophosphamide, lomustine, etoposide) and LEAM (lomustine, etoposide, cytarabine, and melphalan), with the aim to evaluate the results of alternative conditioning regimens using lomustine (LEAM and CLV) and compare them with the standard BEAM regarding early toxicity, engraftment, and transplant related mortality (TRM). All patients developed grade IV neutropenia, anemia with/without transfusion necessity. Severe thrombocytopenia with transfusion requirements is reported in most cases. Median time to platelet engraftment and neutrophil engraftment was 13 days (range) and 10 days (range), respectively. Gastrointestinal toxicity was the most common non-hematologic toxicity after all three conditioning regimens. Oral mucositis in various grades from I to IV was diagnosed in most cases. Other side effects include vomiting, diarrhea, colitis, and skin rash but with low severity grades. For the LEAM arm, one patient died after transplant, before engrafting, one patient didn't achieve platelet engraftment in day 100, one patient developed grade 3 upper gastrointestinal bleeding, one patient died (grade 5 toxicity) with acute renal failure, one patient developed hypoxic events up to grade 4 acute respiratory failure and one patient developed grade 3 itchy skin rash. For the CLV arm, one patient died after transplant, before engrafting, one patient developed grade 3 colitis, one patient with grade 3 hepatic cytolysis, one patient with cardiac toxicity followed by death (grade 5) caused by an acute myocardial infarction with ST elevation and one patient with pulmonary toxicity clinically manifested with grade 3 pleurisy. For the BEAM arm, one patient developed grade 3 cardiac toxicity with sinus bradycardia and afterwards grade 4 with acute pulmonary edema, three patients presented a grade 3 pruritic skin rash and two patients developed grade 3 seizures. In the present study we presented the differences that were observed between BEAM, LEAM, and CLV conditioning regimens offering clinical arguments for an SCT practitioner choice in the ideal situation, but also of choice for alternative regimens in the case that one regimen cannot be used.
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Affiliation(s)
- Andrei Colita
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Anca Colita
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Horia Bumbea
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, University Hospital, Bucharest, Romania
| | - Adina Croitoru
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Carmen Orban
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Lavinia Eugenia Lipan
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Oana-Gabriela Craciun
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Dan Soare
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, University Hospital, Bucharest, Romania
| | - Cecilia Ghimici
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Raluca Manolache
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Ionel Gelatu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Ana-Maria Vladareanu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sergiu Pasca
- Department of Hematology, Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Anca Lupu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Daniel Coriu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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10
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Gemcitabine, vinorelbine and dexamethasone: A safe and effective regimen for treatment of relapsed/refractory hodgkin's lymphoma. Leuk Res 2019; 84:106188. [PMID: 31325732 DOI: 10.1016/j.leukres.2019.106188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Salvage regimens in relapsed/refractory Hodgkin's lymphoma (HL) differ in their efficacy and toxicity profiles. Gemcitabine (G), vinorelbine (V) and liposomal doxorubicin (GVDoxil) is one regimen with high response rates but has high toxicity and cost. We devised a regimen of GVDex by substituting the more expensive liposomal doxorubicin with the cheaper high-dose dexamethasone (Dex). PATIENTS AND METHODS We analyzed the data of 48 adult and paediatric patients of relapsed/refractory HL who received GVDex as salvage therapy. GVDex was delivered as outpatient once in 3 weeks (Q3 weekly) (G 1000 mg/m2 IV over 30 min on D1, 8; V 25 mg/m2 IV fast infusion on D1, 8; Dex40 mg PO D1-4) for 2-3 cycles. We present the overall response rate, toxicity, progression-free (PFS) and overall survival (OS) from the time of start of GVDex. RESULTS Forty-eight patients [median age: 24 years (5-63)] received GVDex [(median cycles:3(1-6)] in this period. Median time from diagnosis to the first relapse was 18.9 (2-119) months. Overall response rate [ORR = complete (CR)+partial (PR)] was 63%. Eleven (23%) patients developed febrile neutropenia. After a median follow-up of 20 months, the Kaplan-Meier estimates of patients alive and progression-free at 24 months were 60% and 49%, respectively. CONCLUSIONS The response rates with GVDex were comparable to those reported with GVDoxil when used as a first-line salvage regimen in relapsed/refractory HL. It was an effective regimen even in patients who failed 2 lines of therapy for HL.
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11
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Kriegsmann K, Rieger M, Schwarzbich MA, Sitter S, Kriegsmann M, Bruckner T, Hensel M, Ho AD, Witzens-Harig M, Wuchter P. Outcome after high-dose chemotherapy and autologous stem cell transplantation in patients with aggressive B-cell non-Hodgkin's lymphoma. Eur J Haematol 2018; 101:12-20. [PMID: 29575332 DOI: 10.1111/ejh.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE For more than two decades, high-dose chemotherapy (HDT) and autologous blood stem cell transplantation (ABSCT) were treatment options for patients with aggressive B-cell non-Hodgkin's lymphoma (B-NHL). However, the ideal timing and the collective patient benefits are still being debated. METHOD We retrospectively analyzed the data of 163 patients with B-NHL who received an HDT protocol followed by ABSCT between 2001 and 2007. Patients were analyzed according to the time point of HDT/ABSCT to compare upfront (directly after induction, n = 72, 44%) versus secondary transplantation (at first relapse, n = 91, 56%). RESULTS The overall response rate was 100% and 94% after upfront and secondary HDT/ABSCT, respectively. No significant differences were found for hematopoietic recovery and toxicity profile. The progression-free survival (PFS) and overall survival (OS) probability were found to be significantly higher in the upfront HDT/ABSCT treatment group (P = .018 and P = .004). In multivariate analysis, upfront HDT/ABSCT and low IPI risk score had a significant beneficial effect on OS (P = .031 and P = .019). CONCLUSION HDT and ABSCT directly after induction chemotherapy were confirmed to be feasible with high PFS and OS rates. In addition, for patients with relapse after first-line therapy and consecutively poor prognosis, HDT/ABSCT also offers an effective treatment strategy.
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Affiliation(s)
| | | | | | - Sören Sitter
- Department of Medicine V, Heidelberg University, Heidelberg, Germany.,Praxis Dr. Sitter, Bechhofen an der Heide, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | | | - Anthony Dick Ho
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | | | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
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