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Holmberg LA, Maloney DG, Connelly-Smith L. Bortezomib and Vorinostat Therapy as Maintenance Therapy Post-Autologous Transplant for Non-Hodgkin's Lymphoma Using R-BEAM or BEAM Transplant Conditioning Regimen. Acta Haematol 2023; 147:300-309. [PMID: 37708877 DOI: 10.1159/000533944] [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: 01/06/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The success of autologous stem cell transplantation (ASCT) for treating non-Hodgkin's lymphoma (NHL) is limited by its high relapse rates. To reduce the risk of relapse, additional maintenance therapy can be added post-transplant. In a non-transplant setting at the time of initiation of this study, both bortezomib and vorinostat had been studied alone or in combination for some NHL histology and showed some clinical activity. At our center, this combination therapy post-transplant for multiple myeloma showed acceptable toxicity. Therefore, it seemed reasonable to study this combination therapy post-ASCT for NHL. METHODS NHL patients underwent conditioning for ASCT with rituximab, carmustine, etoposide, cytarabine, melphalan/carmustine, etoposide, cytarabine, melphalan. After recovery from the acute transplant-related toxicity, combination therapy with IV bortezomib and oral vorinostat (BV) was started and was given for a total of 12 (28-day) cycles. RESULTS Nineteen patients received BV post-ASCT. The most common toxicities were hematologic, gastrointestinal, metabolic, fatigue, and peripheral neuropathy. With a median follow-up of 10.3 years, 11 patients (58%) are alive without disease progression and 12 patients (63%) are alive. CONCLUSIONS BV can be given post-ASCT for NHL and produces excellent disease-free and overall survival rates.
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Affiliation(s)
- Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Laura Connelly-Smith
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Li J, Zhu Y. Survival analysis of multiple myeloma patients after autologous stem cell transplantation. Stem Cell Investig 2020; 6:42. [PMID: 32039264 DOI: 10.21037/sci.2019.10.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/08/2019] [Indexed: 11/06/2022]
Abstract
Background Hematopoietic stem cell transplantation has been applied to treat the hematologic malignancies since the 1980s. However, allogenic transplantation has inherent complications such as graft-versus-host disease and graft failure. Autologous transplantation has become more and more popular because of its lower transplant-related mortality. This study was performed to analyze the possible prognostic factors for myeloma patients post stem cell transplantation. Methods Patients' information was collected by history review and follow-up through the phone call. Kaplan-Meier was used to exhibit overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were performed using Cox proportional hazards model. A P<0.05 is considered statistically significant. Results Thirty patients with multiple myeloma were included in this study, 7 of them died because of myeloma relapse and myeloma-associated complications. The average survival time was 29.8 months and the median follow-up was 25.1 months. The 1-year OS and PFS were 93.3% and 90.0%, respectively. Both the 3-year OS and PFS were 76.7%. In a variety of factors, improved renal function showed a good effect on the outcome of transplantation. Conclusions To prevent cancer relapse after autologous transplantation, it is of great significance to achieve a complete remission prior to the transplantation.
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Affiliation(s)
- Ju Li
- Department of Hematology, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Yan Zhu
- Department of Hematology, Southwest Hospital, Army Medical University, Chongqing 400038, China
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3
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Dhakal P, Chen B, Giri S, Vose JM, Armitage JO, Bhatt VR. Effects of center type and socioeconomic factors on early mortality and overall survival of diffuse large B-cell lymphoma. Future Oncol 2019; 15:2113-2124. [DOI: 10.2217/fon-2018-0596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: To examine whether the center type and socioeconomic factors significantly impact 1-month mortality and overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL). Methods: National Cancer Database (NCDB) was used to identify patients diagnosed with diffuse large B-cell lymphoma from 2006 to 2012 (postrituximab era). Results: Among 185,183 patients, 33% were treated at academic centers. The receipt of therapy at larger volume centers was associated with improved 1-month mortality. Academic centers had better OS than nonacademic centers in univariable analysis. Younger age, private insurance, lower Charlson comorbidity score and lower lymphoma stage were associated with improved 1-month mortality and OS. Conclusion: The receipt of therapy at larger volume centers and socioeconomic factors were associated with improved survival.
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Affiliation(s)
- Prajwal Dhakal
- Department of Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Internal Medicine, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Baojiang Chen
- Department of Biostatistics, University of Texas Health Science Center at Houston, College of Public Health in Austin, Austin, TX 78701, USA
| | - Smith Giri
- Department of Internal Medicine, Division of Hematology & Oncology, Yale University, New Haven, CT 06510, USA
| | - Julie M Vose
- Department of Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Internal Medicine, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - James O Armitage
- Department of Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Internal Medicine, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Internal Medicine, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
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BEAM or BUCYVP16-conditioning regimen for autologous stem-cell transplantation in non-Hodgkin’s lymphomas. Bone Marrow Transplant 2019; 54:1553-1561. [DOI: 10.1038/s41409-019-0463-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/09/2022]
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5
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Robertson MJ, Stamatkin CW, Pelloso D, Weisenbach J, Prasad NK, Safa AR. A Dose-escalation Study of Recombinant Human Interleukin-18 in Combination With Ofatumumab After Autologous Peripheral Blood Stem Cell Transplantation for Lymphoma. J Immunother 2018; 41:151-157. [PMID: 29517616 PMCID: PMC5847481 DOI: 10.1097/cji.0000000000000220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interleukin-18 (IL-18) is an immunostimulatory cytokine that augments antibody-dependent cellular cytotoxicity mediated by human natural killer cells against antibody-coated lymphoma cells in vitro and that has antitumor activity in animal models. Ofatumumab is a CD20 monoclonal antibody with activity against human B-cell lymphomas. A phase I study of recombinant human (rh) IL-18 given with ofatumumab was undertaken in patients with CD20 lymphoma who had undergone high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Cohorts of 3 patients were given intravenous infusions of ofatumumab 1000 mg weekly for 4 weeks with escalating doses of rhIL-18 as a intravenous infusion weekly for 8 consecutive weeks. Nine male patients with CD20 lymphomas were given ofatumumab in combination with rhIL-18 at doses of 3, 10, and 30 μg/kg. No unexpected or dose-limiting toxicities were observed. The mean reduction from predose levels in the number of peripheral blood natural killer cells after the first rhIL-18 infusion was 91%, 96%, and 97% for the 3, 10, and 30 μg/kg cohorts, respectively. Serum concentrations of interferon-γ and chemokines transiently increased following IL-18 dosing. rhIL-18 can be given in biologically active doses by weekly infusions in combination with ofatumumab after peripheral blood stem cell transplantation to patients with lymphoma. A maximum tolerated dose of rhIL-18 plus ofatumumab was not determined. Further studies of rhIL-18 and CD20 monoclonal antibodies in B-cell malignancies are warranted.
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Affiliation(s)
- Michael J. Robertson
- Lymphoma Program and Bone Marrow and Stem Cell Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Christopher W. Stamatkin
- Therapeutic Validation Core, Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - David Pelloso
- Lymphoma Program and Bone Marrow and Stem Cell Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jill Weisenbach
- Lymphoma Program and Bone Marrow and Stem Cell Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Nagendra K. Prasad
- Therapeutic Validation Core, Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Ahmad R. Safa
- Therapeutic Validation Core, Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN
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Bhatt VR, Vose JM. Hematopoietic Stem Cell Transplantation for Non-Hodgkin Lymphoma. Hematol Oncol Clin North Am 2014; 28:1073-95. [DOI: 10.1016/j.hoc.2014.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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7
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Al-Malki MM, Castillo JJ, Sloan JM, Re A. Hematopoietic Cell Transplantation for Plasmablastic Lymphoma: A Review. Biol Blood Marrow Transplant 2014; 20:1877-84. [DOI: 10.1016/j.bbmt.2014.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/06/2014] [Indexed: 01/23/2023]
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8
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Ghobadi A, Nolley E, Liu J, McBride A, Stockerl-Goldstein K, Cashen A. Retrospective comparison of allogeneic vs autologous transplantation for diffuse large B-cell lymphoma with early relapse or primary induction failure. Bone Marrow Transplant 2014; 50:134-6. [PMID: 25243626 DOI: 10.1038/bmt.2014.198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A Ghobadi
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - E Nolley
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - J Liu
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA
| | - A McBride
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - K Stockerl-Goldstein
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - A Cashen
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
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Vose JM, Habermann TM, Czuczman MS, Zinzani PL, Reeder CB, Tuscano JM, Lossos IS, Li J, Pietronigro D, Witzig TE. Single-agent lenalidomide is active in patients with relapsed or refractory aggressive non-Hodgkin lymphoma who received prior stem cell transplantation. Br J Haematol 2013; 162:639-47. [DOI: 10.1111/bjh.12449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/22/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Julie M. Vose
- University of Nebraska Medical Center; Omaha; NE; USA
| | | | | | - Pier Luigi Zinzani
- Institute of Haematology and Oncology Seragnoli; University of Bologna; Bologna; Italy
| | | | | | | | - Ju Li
- Celgene Corporation; Summit; NJ; USA
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Yao S, Hahn T, Zhang Y, Haven D, Senneka M, Dunford L, Parsons S, Confer D, McCarthy PL. Unrelated donor allogeneic hematopoietic cell transplantation is underused as a curative therapy in eligible patients from the United States. Biol Blood Marrow Transplant 2013; 19:1459-64. [PMID: 23811537 DOI: 10.1016/j.bbmt.2013.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) is a curative therapy for hematologic disorders including acute lymphoblastic and myeloid leukemia, chronic lymphocytic and myeloid leukemia, Hodgkin's and non-Hodgkin lymphoma, multiple myeloma, and myelodysplastic syndrome. To determine the utilization of alloHCT from unrelated donors (URDs) in the United States, we calculated the number of patients diagnosed with hematologic disorders age 20 to 74 years based on 2004 to 2008 Surveillance, Epidemiology and End Results and 2007 US Census data, estimated the percentage of patients who would be eligible for URD alloHCT after discounting the mortality rate during induction therapy and the rate of severe comorbidities, and compared these with the actual 2007 alloHCTs facilitated by the National Marrow Donor Program. We found that the number of URD alloHCT as a percentage of the estimated potential transplantations ranged from 11% for multiple myeloma to 54% for chronic myeloid leukemia, with an average percentage of 26% for all the disorders considered. In an analysis stratified by age groups (20 to 44, 45 to 64, and 65 to 74 years), the utilization of URD alloHCT was higher in younger patients than in older patients for all disorders. Of acute lymphoblastic and myeloid leukemia patients, approximately 66% underwent URD alloHCT later in the course of their disease (in second or greater complete remission). URD alloHCT is likely underused for potentially curable hematologic disorders, particularly in older patients. Understanding the reasons for low use of alloHCT may lead to strategies to expand the use of this curative therapy for more patients with hematologic disorders.
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Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
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Vijay A, Duan Q, Henning JW, Duggan P, Daly A, Shafey M, Bahlis NJ, Stewart DA. High dose salvage therapy with dose intensive cyclophosphamide, etoposide and cisplatin may increase transplant rates for relapsed/refractory aggressive non-Hodgkin lymphoma. Leuk Lymphoma 2013; 54:2620-6. [DOI: 10.3109/10428194.2013.783211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Morawa E, Martin P, Gergis U, van Besien K, Shore T. Autologous stem cell transplant in human immunodeficiency virus-positive patients with lymphoid malignancies: focus on infectious complications. Leuk Lymphoma 2012; 54:885-8. [DOI: 10.3109/10428194.2012.721543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Anoop P, Sankpal S, Stiller C, Tewari S, Lancaster DL, Khabra K, Taj MM. Outcome of childhood relapsed or refractory mature B-cell non-Hodgkin lymphoma and acute lymphoblastic leukemia. Leuk Lymphoma 2012; 53:1882-8. [PMID: 22448922 DOI: 10.3109/10428194.2012.677534] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with childhood relapsed and refractory mature B-cell non-Hodgkin lymphoma (B-NHL) and acute lymphoblastic leukemia (B-ALL) are rare and have a dismal prognosis. The previous UK national analysis of 26 children over a 7-year period prior to 1996 had highlighted the poor outcome, with only three survivors. This 10-year multicenter study evaluated recent data, since 2000. Of 33 children, nine survived (27.3%), with a median follow-up of 4.3 years. On exclusion of six children treated with palliative intent, the survival was one-third (nine of 27; 33.3%). All patients with primary refractory disease (n = 7) and all except one with early relapse (n = 11) died. Administration of four doses of 375 mg/m(2) of rituximab was associated with a longer survival (p = 0.006). Response to reinduction (p < 0.001) and autologous hematopoietic stem cell transplant (auto-HSCT) (p = 0.003) were significant on multivariate analysis. Patients with a time to relapse of at least 6 months are potentially curable and must be offered intensive treatment with salvage chemotherapy, rituximab and auto-HSCT.
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Affiliation(s)
- Parameswaran Anoop
- Department of Paediatric Haemato-Oncology, Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, UK
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Oliansky DM, Larson RA, Weisdorf D, Dillon H, Ratko TA, Wall D, McCarthy PL, Hahn T. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of adult acute lymphoblastic leukemia: update of the 2006 evidence-based review. Biol Blood Marrow Transplant 2011; 17:20-47.e30. [PMID: 20656046 DOI: 10.1016/j.bbmt.2010.07.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/13/2010] [Indexed: 11/29/2022]
Abstract
Clinical research published since the first evidence-based review on the role of hematopoietic stem cell transplantation (SCT) in the treatment of acute lymphoblastic leukemia (ALL) in adults is presented and critically evaluated in this update. Treatment recommendations changed or modified based on new evidence include: (1) myeloablative allogeneic SCT is an appropriate treatment for adult (<35 years) ALL in first complete remission for all disease risk groups; and (2) reduced-intensity conditioning may produce similar outcomes to myeloablative regimens. Treatment recommendations unchanged or strengthened by new evidence include: (1) allogeneic SCT is recommended over chemotherapy for ALL in second complete remission or greater; (2) allogeneic is superior to autologous SCT; and (3) there are similar survival outcomes after related and unrelated allogeneic SCT. New treatment recommendations based on new evidence include: (1) in the absence of a suitable allogeneic donor, autologous SCT may be an appropriate therapy, but results in a high relapse rate; (2) it is appropriate to consider cord blood transplantation for patients with no HLA well-matched donor; and (3) imatinib therapy before and/or after SCT (for Ph+ ALL) yields significantly superior survival outcomes. Areas of needed research in the treatment of adult ALL with SCT were identified and presented in the review.
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Abstract
Since the introduction of highly active antiretroviral therapy, the natural history of HIV infection has changed dramatically, and with it the epidemiology of HIV-related lymphoma. HIV-related lymphomas have increased as a percentage of first AIDS-defining illness. The most prevalent of the HIV-related lymphomas is diffuse large B-cell non-Hodgkin’s lymphoma, followed by Burkitt’s lymphoma. Although not considered an AIDS-defining illness, Hodgkin’s lymphoma is increasing in incidence in those with HIV infection. Treatment outcome and prognosis has improved significantly over the last decade. Paradigms of therapy have shifted, with approaches aimed at complete remission rather than palliation. This review discusses the biology and changes in epidemiology of HIV-related lymphoma and also reviews other key developments in the management of this disease.
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Affiliation(s)
- Belinda Lee
- Department of Oncology Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - Mark Bower
- Department of Oncology Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - Thomas Newsom-Davis
- Department of Oncology Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - Mark Nelson
- HIV Medicine, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
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Naparstek E. The role of rituximab in autologous and allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphoma. Curr Hematol Malig Rep 2010; 1:220-9. [PMID: 20425317 DOI: 10.1007/s11899-006-0003-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The addition of rituximab to chemotherapy has substantially changed the treatment strategies for patients with B-cell lymphomas. Rituximab, combined with standard chemotherapy regimens, shows consistently improved results compared with chemotherapy alone and has been extensively employed in both newly diagnosed and relapsed patients with B-cell lymphoma. Because of its low toxicity profile and its potent antilymphoma activity mediated through direct apoptotic and indirect effector mechanisms, rituximab also has been actively incorporated into stem cell transplantation (SCT) protocols to attain a state of minimal disease, provide a safe and effective method for in vivo purging prior to autologous SCT, and promote graft-versus-lymphoma effects in allogeneic SCT. This review compiles the still immature but rapidly growing data on this combined modality.
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Affiliation(s)
- Elizabeth Naparstek
- Department of Hematology and BMT, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 64239, Tel-Aviv, Israel.
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High probability of long-term survival in 2-year survivors of autologous hematopoietic cell transplantation for AML in first or second CR. Bone Marrow Transplant 2010; 46:385-92. [PMID: 20479710 PMCID: PMC2978251 DOI: 10.1038/bmt.2010.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe the long-term outcomes of autologous hematopoietic cell transplantation (HCT) for 315 AML patients in first or second complete remission (CR). All patients were in continuous CR for ≥2 years after HCT. Patients were predominantly transplanted in CR1 (78%) and had good or intermediate cytogenetic risk disease (74%). Median follow-up of survivors was 106 (range, 24-192) months. Overall survival at 10 years after HCT was 94% (95% confidence intervals, 89-97%) and 80% (67-91%) for patients receiving HCT in CR1 and CR2, respectively. The cumulative incidence of relapse at 10 years after HCT was 6% (3-10%) and 10% (3-20%) and that of nonrelapse mortality was 5% (2-9%) and 11% (4-21%), respectively. On multivariate analysis, HCT in CR2 (vs CR1), older age at transplantation and poor cytogenetic risk disease were independent predictors of late mortality and adverse disease-free survival. The use of growth factors to promote engraftment after HCT was the only risk factor for relapse. Relative mortality of these 2-year survivors was comparable to that of age-, race- and gender-matched normal population. Patients who receive autologous HCT for AML in CR1 or CR2 and remain in remission for ≥2 years have very favorable long-term survival. Their mortality rates are similar to that of the general population.
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Li M, Gao C, Li H, Wang Z, Cao Y, Huang W, Li X, Wang S, Yu L, Da W. Allogeneic haematopoietic stem cell transplantation as a salvage strategy for relapsed or refractory nasal NK/T-cell lymphoma. Med Oncol 2010; 28:840-5. [DOI: 10.1007/s12032-010-9532-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Loberiza FR, Cannon AJ, Weisenburger DD, Vose JM, Moehr MJ, Bast MA, Bierman PJ, Bociek RG, Armitage JO. Survival disparities in patients with lymphoma according to place of residence and treatment provider: a population-based study. J Clin Oncol 2009; 27:5376-82. [PMID: 19752339 DOI: 10.1200/jco.2009.22.0038] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care. PATIENTS AND METHODS Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006. RESULTS Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB), and 861 (37%) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB. CONCLUSION Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.
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Affiliation(s)
- Fausto R Loberiza
- Section of Oncology-Hematology, Summer Undergraduate Research Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft? Bone Marrow Transplant 2009; 44:559-69. [PMID: 19701250 DOI: 10.1038/bmt.2009.214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although autologous hematopoietic SCT (auto-HSCT) is the only potentially curative treatment for lymphoma that has relapsed after conventional chemotherapy, the prognosis of patients with disease recurrence after auto-HSCT is poor. Some highly selected patients can benefit from second transplants. One-third with late recurrence after initial auto-HSCT may attain a prolonged remission after second auto-HSCT. Non-myeloablative or reduced-intensity conditioning (RIC) allogeneic hematopoietic SCT (allo-HSCT) has been used successfully after auto-HSCT failures, especially in subjects who have an HLA-compatible donor, chemosensitive disease and good performance status. Patients with chemosenstive disease recurrence who have completed at least 1 year after their first auto-HSCT should be considered for a second auto-HSCT. Patients who have chemoresistant disease are best served by participation in a well-designed clinical trial examining novel antitumor agents.
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Majhail NS, Bajorunaite R, Lazarus HM, Wang Z, Klein JP, Zhang MJ, Rizzo JD. Long-term survival and late relapse in 2-year survivors of autologous haematopoietic cell transplantation for Hodgkin and non-Hodgkin lymphoma. Br J Haematol 2009; 147:129-39. [PMID: 19573079 DOI: 10.1111/j.1365-2141.2009.07798.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study described long-term outcomes of autologous haematopoietic-cell transplantation (HCT) for advanced Hodgkin (HL) and non-Hodgkin lymphoma (NHL). The study included recipients of autologous HCT for HL (N = 407) and NHL (N = 960) from 1990-98 who were in continuous complete remission for at least 2 years post-HCT. Median follow-up was 104 months for HL and 107 months for NHL. Overall survival at 10-years was 77% (72-82%) for HL, 78% (73-82%) for diffuse large-cell NHL, 77% (71-83%) for follicular NHL, 85% (75-93%) for lymphoblastic/Burkitt NHL, 52% (37-67%) for mantle-cell NHL and 77% (67-85%) for other NHL. On multivariate analysis, mantle-cell NHL had the highest relative-risk for late mortality [2.87 (1.70-4.87)], while the risks of death for other histologies were comparable. Relapse was the most common cause of death. Relative mortality compared to age, race and gender adjusted normal population remained significantly elevated and was 14.8 (6.3-23.3) for HL and 5.9 (3.6-8.2) for NHL at 10-years post-HCT. Recipients of autologous HCT for HL and NHL who remain in remission for at least 2-years have favourable subsequent long-term survival but remain at risk for late relapse. Compared to the general population, mortality rates continue to remain elevated at 10-years post-transplantation.
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Affiliation(s)
- Navneet S Majhail
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA.
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22
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Comparable survival between HIV+ and HIV− non-Hodgkin and Hodgkin lymphoma patients undergoing autologous peripheral blood stem cell transplantation. Blood 2009; 113:6011-4. [DOI: 10.1182/blood-2008-12-195388] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractAutologous stem cell transplantation (ASCT) has been successfully used in HIV-related lymphoma (HIV-Ly) patients on highly active antiretroviral therapy. We report the first comparative analysis between HIV-Ly and a matched cohort of HIV− lymphoma patients. This retrospective European Group for Blood and Marrow Transplantation study included 53 patients (66% non-Hodgkin and 34% Hodgkin lymphoma) within each cohort. Both groups were comparable except for the higher proportion of males, mixed-cellularity Hodgkin lymphoma and patients receiving granulocyte colony-stimulating factor before engraftment and a smaller proportion receiving total body irradiation-based conditioning within the HIV-Ly cohort. Incidence of relapse, overall survival, and progression-free survival were similar in both cohorts. A higher nonrelapse mortality within the first year after ASCT was observed in the HIV-Ly group (8% vs 2%), predominantly because of early bacterial infections, although this was not statistically significant and did not influence survival. Thus, within the highly active antiretroviral therapy era, HIV patients should be considered for ASCT according to the same criteria adopted for HIV− lymphoma patients.
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23
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Balsalobre P, Díez-Martín JL, Re A, Michieli M, Ribera JM, Canals C, Rosselet A, Conde E, Varela R, Cwynarski K, Gabriel I, Genet P, Guillerm G, Allione B, Ferrant A, Biron P, Espigado I, Serrano D, Sureda A. Autologous Stem-Cell Transplantation in Patients With HIV-Related Lymphoma. J Clin Oncol 2009; 27:2192-8. [DOI: 10.1200/jco.2008.18.2683] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PurposePeripheral-blood autologous stem-cell transplantation (ASCT) in patients with HIV-related lymphoma (HIV-Ly) has been reported as a safe and useful procedure. Herein we report the European Group for Blood and Marrow Transplantation experience on patients with HIV-Ly undergoing ASCT.Patients and MethodsThis was a retrospective, multicentric, registry-based analysis.ResultsSince 1999, 68 patients from 20 institutions (median age, 41 years; range, 29 to 62 years) were included, diagnosed with non-Hodgkin's lymphoma (NHL; n = 50) or Hodgkin's lymphoma (n = 18). At the time of ASCT, 16 patients were in first complete remission (CR1); 44 patients were in CR more than 1, partial remission, or chemotherapy-sensitive relapse (chemo-S); and eight patients had chemotherapy-resistant disease. The median number of CD34+cells infused was 4.5 × 106/kg (range, 1.6 to 21.2 × 106/kg). Median time to neutrophil and platelet engraftment were 11 days (range, 8 to 36 days) and 14 days (range, 6 to 455 days), respectively, with a cumulative incidence (CI) at 1 year of 95.6% and 87%, respectively. CI of nonrelapse mortality (NRM) was 7.5% at 12 months after ASCT, mainly because of bacterial infections. CI of relapse was 30.4% at 24 months, statistically related with not being in CR at ASCT (relative risk [RR] = 3.6), NHL histology other than diffuse large B-cell lymphoma (RR = 3.4), and use of more than two previous treatment lines (RR = 3). At a median follow-up of 32 months (range, 2 to 81 months), progression-free survival (PFS) was 56%. Patients not in CR or with refractory disease at ASCT had poorer PFS (RR = 2.4 and 4.8, respectively).ConclusionSimilarly to HIV-negative patients with lymphoma, ASCT is a useful treatment for patients with HIV-Ly and is associated with low NRM, mainly when performed in early stages and chemo-S disease.
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Affiliation(s)
- Pascual Balsalobre
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - José L. Díez-Martín
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Alessandro Re
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Mariagrazia Michieli
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - José M. Ribera
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Carmen Canals
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Anne Rosselet
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Eulogio Conde
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Rosario Varela
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Kate Cwynarski
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Ian Gabriel
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Philippe Genet
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Gaelle Guillerm
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Bernardino Allione
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Augustin Ferrant
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Pierre Biron
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Ildefonso Espigado
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - David Serrano
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Anna Sureda
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
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Refractory nodular lymphocyte predominant Hodgkin lymphoma transformed to T-cell/histiocyte-rich B-cell lymphoma in an adolescent: salvage therapy with allogeneic bone marrow transplantation. J Pediatr Hematol Oncol 2008; 30:959-62. [PMID: 19131792 DOI: 10.1097/mph.0b013e31818a9564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
According to biologic features, there is a substantial "gray zone" between nodular lymphocyte predominant Hodgkin lymphomas (NLPHLs) (Poppema lymphomas) and T-cell/histiocyte-rich B-cell lymphomas (T/HRBCLs). Transformation from an NLPHL to a T/HRBCL can occur and is associated with a worsening of the prognosis. Here is described a case of a 16-year-old boy who presented with an NLPHL with features of T/HRBCL. Clinical evolution was complicated by 2 relapses leading to autologous and then to allogeneic bone marrow transplantation.
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25
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Lazarus HM, Carreras J, Boudreau C, Loberiza FR, Armitage JO, Bolwell BJ, Freytes CO, Gale RP, Gibson J, Hale GA, Inwards DJ, LeMaistre CF, Maharaj D, Marks DI, Miller AM, Pavlovsky S, Schouten HC, van Besien K, Vose JM, Bitran JD, Khouri IF, McCarthy PL, Yu H, Rowlings P, Serna DS, Horowitz MM, Rizzo JD. Influence of age and histology on outcome in adult non-Hodgkin lymphoma patients undergoing autologous hematopoietic cell transplantation (HCT): a report from the Center For International Blood & Marrow Transplant Research (CIBMTR). Biol Blood Marrow Transplant 2008; 14:1323-33. [PMID: 19041053 PMCID: PMC2638759 DOI: 10.1016/j.bbmt.2008.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 09/12/2008] [Indexed: 12/29/2022]
Abstract
To compare the clinical outcomes of older (age > or =55 years) non-Hodgkin lymphoma (NHL) patients with younger NHL patients (<55 years) receiving autologous hematopoietic cell transplantation (HCT) while adjusting for patient-, disease-, and treatment-related variables, we compared autologous HCT outcomes in 805 NHL patients aged > or =55 years to 1949 NHL patients <55 years during the years 1990-2000 using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). In multivariate analysis, older patients with aggressive histologies were 1.86 times (95% confidence interval [CI] 1.43-2.43, P < .001) more likely than younger patients to experience treatment-related mortality (TRM). Relative death risks were 1.33 times (CI 1.04-1.71, P = .024) and 1.50 times (CI 1.33-16.9, P < .001) higher in older compared to younger patients with follicular grade I/II and aggressive histologies, respectively. Autologous HCT in older NHL patients is feasible, but most disease-related outcomes are statistically inferior to younger patients. Studies addressing supportive care particular to older patients, who are most likely to benefit from this approach, are recommended.
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Affiliation(s)
- Hillard M Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
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Abstract
Despite more effective front-line regimens, a substantial portion of patients with diffuse large B-cell lymphoma relapse and require further therapy. Several trials have established the efficacy of autologous stem cell transplantation for relapsed diffuse large B-cell lymphomas, but the benefit has been largely restricted to patients with chemosensitive disease and low-risk features at the time of relapse. In an effort to improve outcomes following an autologous transplant, researchers are exploring several avenues, including improvement of salvage regimens, addition of radioimmunotherapy to preparative regimens, and application of posttransplant treatments to eliminate minimal residual disease. Allogeneic stem cell transplantation also appears promising, but there is much to learn about optimal patient selection and timing. This review outlines the current approach to the management of relapsed diffuse large B-cell lymphoma, with an emphasis on newer peritransplant therapies.
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27
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Smith SM, van Besien K, Carreras J, Bashey A, Cairo MS, Freytes CO, Gale RP, Hale GA, Hayes-Lattin B, Holmberg LA, Keating A, Maziarz RT, McCarthy PL, Navarro WH, Pavlovsky S, Schouten HC, Seftel M, Wiernik PH, Vose JM, Lazarus HM, Hari P. Second autologous stem cell transplantation for relapsed lymphoma after a prior autologous transplant. Biol Blood Marrow Transplant 2008; 14:904-12. [PMID: 18640574 DOI: 10.1016/j.bbmt.2008.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
We determined treatment-related mortality, progression-free survival (PFS), and overall survival (OS) after a second autologous HCT (HCT2) for patients with lymphoma relapse after a prior HCT (HCT1). Outcomes for patients with either Hodgkin lymphoma (HL, n = 21) or non-Hodgkin lymphoma (NHL, n = 19) receiving HCT2 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) were analyzed. The median age at HCT2 was 38 years (range: 16-61) and 22 (58%) patients had a Karnofsky performance score <90. HCT2 was performed >1 year after HCT1 in 82%. The probability of treatment-related mortality at day 100 was 11% (95% confidence interval [CI], 3%-22%). The 1-, 3-, and 5-year probabilities of PFS were 50% (95% CI, 34%-66%), 36% (95% CI, 21%-52%), and 30% (95% CI, 16%-46%), respectively. Corresponding probabilities of survival were 65% (95% CI, 50%-79%), 36% (95% CI, 22%-52%), and 30% (95% CI, 17%-46%), respectively. At a median follow-up of 72 months (range: 12-124 months) after HCT2, 29 patients (73%) have died, 18 (62%) secondary to relapsed lymphoma. The outcomes of patients with HL and NHL were similar. In summary, this series represents the largest reported group of patients with relapsed lymphomas undergoing SCT2 following failed SCT1, and with long-term follow-up. Our series suggests that SCT2 is feasible in patients relapsing after prior HCT1, with a lower treatment-related mortality than that reported for allogeneic transplant in this setting. HCT2 should be considered for patients with relapsed HL or NHL after HCT1 without alternative allogeneic stem cell transplant options.
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Affiliation(s)
- Sonali M Smith
- Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.
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28
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Hosing C, Saliba RM, Okoroji GJ, Popat U, Couriel D, Ali T, De Padua Silva L, Kebriaei P, Alousi A, De Lima M, Qazilbash M, Anderlini P, Giralt S, Champlin RE, Khouri I. High-dose chemotherapy and autologous hematopoietic progenitor cell transplantation for non-Hodgkin's lymphoma in patients >65 years of age. Ann Oncol 2008; 19:1166-71. [PMID: 18272911 DOI: 10.1093/annonc/mdm608] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PATIENTS AND METHODS We present a retrospective analysis of 99 consecutive patients with relapsed non-Hodgkin's lymphomas who were older than 65 years at the time of high-dose chemotherapy and autologous progenitor cell transplantation. RESULTS Median age at transplant was 68 years (range 65-82). Thirty-six percent of patients had a hematopoietic cell transplantation comorbidity index of >2 at the time of transplantation. The cumulative nonrelapse mortality was 8% [95% confidence interval (CI) 4-17] at 26 months and the 3-year overall survival (OS) was 61% (95% CI 49-71). On multivariate analysis, disease status at transplant and lactate dehydrogenase (LDH) > normal were significant predictors for OS (P = 0.002). Comorbidity index of >2 did not impact OS but did predict for higher risk of developing grade 3-5 toxicity (P = 0.006). Eight patients developed secondary myelodysplastic syndrome/acute myelogenous leukemia after transplantation (cumulative incidence 16%). CONCLUSIONS Patients with relapsed lymphomas who are >65 years of age should be considered transplant candidates, particularly if they have chemosensitive disease and normal LDH levels at the time of transplantation. Patients with comorbidity index of >2 can also undergo transplantation with acceptable outcomes but may be at higher risk for developing toxicity.
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Affiliation(s)
- C Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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29
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Provencio M, Fayad LE. [High-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin's lymphoma]. Med Clin (Barc) 2008; 130:60-5. [PMID: 18221676 DOI: 10.1157/13115028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España.
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Spitzer TR, Ambinder RF, Lee JY, Kaplan LD, Wachsman W, Straus DJ, Aboulafia DM, Scadden DT. Dose-reduced busulfan, cyclophosphamide, and autologous stem cell transplantation for human immunodeficiency virus-associated lymphoma: AIDS Malignancy Consortium study 020. Biol Blood Marrow Transplant 2008; 14:59-66. [PMID: 18158962 DOI: 10.1016/j.bbmt.2007.03.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 03/19/2007] [Indexed: 12/12/2022]
Abstract
Intensive chemotherapy for human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) has resulted in durable remissions in a substantial proportion of patients. High-dose chemotherapy and autologous stem cell transplantation (AuSCT), moreover, has resulted in sustained complete remissions in selected patients with recurrent chemosensitive disease. Based on a favorable experience with dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT for older patients with non-HIV-associated aggressive lymphomas, an AIDS Malignancy Consortium multicenter trial was undertaken using the same dose-reduced busulfan and cyclophosphamide preparative regimen with AuSCT for recurrent HIV-associated NHL and HL. Of the 27 patients in the study, 20 received an AuSCT. The median time to achievement of an absolute neutrophil count (ANC) of >or= 0.5 x 10(9)/L was 11 days (range, 9-16 days). The median time to achievement of an unsupported platelet count of >or= 20 x 10(9)/L was 13 days (range, 6-57 days). One patient died on day +33 posttransplantation from hepatic veno-occlusive disease (VOD) and multiorgan failure. No other fatal regimen-related toxicity occurred. Ten of 19 patients (53%) were in complete remission at the time of their day +100 post-AuSCT evaluation. Of the 20 patients, 10 were alive and event-free at a median of 23 weeks post-AuSCT. Median overall survival (OS) was not reached by 13 of the 20 patients alive at the time of last follow-up. This multi-institutional trial demonstrates that a regimen of dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT is well tolerated and is associated with favorable disease-free survival (DFS) and OS probabilities for selected patients with HIV-associated NHL and HL.
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Affiliation(s)
- Thomas R Spitzer
- Bone Marrow Transplant Program, Massachusetts General Hospital, 0 Emerson Place, Suite 118, 55 Fruit Street, Boston, MA 02114, USA
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Oehler-Jänne C, Taverna C, Stanek N, Negretti L, Lütolf UM, Ciernik IF. Consolidative involved field radiotherapy after high dose chemotherapy and autologous stem cell transplantation for non-Hodgkin's lymphoma: a case-control study. Hematol Oncol 2008; 26:82-90. [DOI: 10.1002/hon.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rao K, Darrington DL, Schumacher JJ, Devetten M, Vose JM, Loberiza FR. Disparity in Survival Outcome after Hematopoietic Stem Cell Transplantation for Hematologic Malignancies According to Area of Primary Residence. Biol Blood Marrow Transplant 2007; 13:1508-14. [DOI: 10.1016/j.bbmt.2007.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
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Wendland MMM, Smith DC, Boucher KM, Asch JD, Pulsipher MA, Thomson JW, Shrieve DC, Gaffney DK. The impact of involved field radiation therapy in the treatment of relapsed or refractory non-Hodgkin lymphoma with high-dose chemotherapy followed by hematopoietic progenitor cell transplant. Am J Clin Oncol 2007; 30:156-62. [PMID: 17414465 DOI: 10.1097/01.coc.0000251242.32763.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with refractory/relapsed non-Hodgkin lymphoma (NHL) often receive high-dose chemotherapy (HDCT) followed by hematopoietic progenitor cell transplant (HPCT) as salvage therapy. We examined the role of involved field radiation therapy (IFRT) in this setting. METHODS The records of 167 patients with refractory/relapsed NHL who underwent HDCT followed by HPCT between February 1990 and November 2003 were reviewed. Fifty-three patients received IFRT and 114 did not receive IFRT in the peritransplant period. RESULTS Eighty patients were alive at the time of analysis with a median follow up for alive patients of 4.5 years in the no IFRT group and 4.2 years in the IFRT group (P = 0.53). Patients undergoing IFRT were more likely to have bulky (P = 0.02) and extranodal (P= 0.04) disease at initial diagnosis. There was no significant difference between the treatment groups regarding mortality in the first 100 days after HPCT (P = 0.31). Five-year overall survival rates were 46.7% for the no IFRT group and 40.0% for the IFRT group (P= 0.15). Disease-free survival was significantly worse for patients receiving IFRT (P = 0.02); however, when considering local control, the addition of IFRT resulted in a 5-year rate similar to that for patients who did not receive IFRT (68.6% vs. 72.0% respectively, P= 0.73). CONCLUSIONS Although disease-free survival was inferior in patients who received IFRT, despite more adverse clinical features the use of IFRT resulted in similar rates of local control and overall survival compared with those who did not receive IFRT. The use of IFRT was not associated with an increase in the risk of acute mortality or late events.
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Affiliation(s)
- Merideth M M Wendland
- Department of Radiation Oncology, Huntsman Cancer Hospital and the University of Utah, Salt Lake City, Utah 84112, USA
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Lerner RE, Thomas W, Defor TE, Weisdorf DJ, Burns LJ. The International Prognostic Index assessed at relapse predicts outcomes of autologous transplantation for diffuse large-cell non-Hodgkin's lymphoma in second complete or partial remission. Biol Blood Marrow Transplant 2007; 13:486-92. [PMID: 17382255 DOI: 10.1016/j.bbmt.2006.12.452] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 12/21/2006] [Indexed: 11/30/2022]
Abstract
Autologous hematopoietic stem cell transplantation (auto HSCT) has become the standard treatment for patients with relapsed diffuse large-cell non-Hodgkin's lymphoma (NHL) responding to conventional salvage chemotherapy. Nevertheless, more than half of these patients will relapse following auto HSCT and die. This study was undertaken to determine whether the International Prognostic Index (IPI) assessed at time of relapse (IPI-R) could be used to identify patients with greater probability for long-term survival following auto HSCT. Eighty patients, median age 47 years (range 19-68 years), with diffuse large cell lymphoma in either second complete remission (CR 2, n = 27) or partial remission (PR 2, n = 53) were treated between 1984 and 2002 with auto HSCT. Clinical features predictive of overall survival (OS) and progression-free survival (PFS) were analyzed. Post-auto HSCT, CR was achieved in 73 patients (91%). With a median follow-up of 5 years (range 1.0-14.2 years), OS and PFS at 5 years were 38% (95% confidence interval [CI] 27%-50%) and 32% (95% CI 22%-42%), respectively. Two risk groups with significantly different OS and PFS were identified by the IPI-R. The high-risk group (3, 4, or 5 IPI factors) had 2.0 times (95% CI 1.1-4.0, P = .03) the risk of death and 2.2 times (95% CI 1.2-4.0, P = .01) the risk of relapse as the low-risk group (0, 1, or 2 IPI factors). The median OS was 5 months versus 27 months and the median PFS was 2 months versus 8 months for the high- and low-risk IPI-R groups, respectively. In Cox regression analysis, high-risk IPI-R status (relative risk [RR] 2.4, 95% CI 1.2-4.8, P = .02) and bone marrow (BM) involvement at diagnosis (RR 2.9, 95% CI 1.3-6.4, P = .01) were independent predictors for poor OS. Similarly, high-risk IPI-R status (RR 2.5, 95% CI 1.3-4.7, P = .01) and BM involvement at diagnosis (RR 3.9, 95% CI 1.7-8.7, P = .001) were independent predictors for poor PFS. These results suggest that the IPI-R predicts OS and PFS following auto HSCT for patients with aggressive NHL in CR 2 or PR 2. Patients with high-risk IPI-R should be considered for novel therapeutic approaches.
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Affiliation(s)
- Rachel E Lerner
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Holmberg LA, Maloney D, Bensinger W. Immunotherapy with rituximab/interleukin-2 after autologous stem cell transplantation as treatment for CD20+ non-Hodgkin's lymphoma. ACTA ACUST UNITED AC 2006; 7:135-9. [PMID: 17026825 DOI: 10.3816/clm.2006.n.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Relapse of non-Hodgkin's lymphoma (NHL) remains a problem after autologous stem cell transplantation (ASCT). Soon after ASCT, the immune system is not very active, and this immune incompetence could thus result in decreased ability for immune-mediated tumor eradication. The early addition of immunotherapy after ASCT might decrease the incidence of relapse and prolong survival. In an initial phase I/II trial at our center, the immune modulator interleukin-2 (IL-2) increased over baseline natural killer and lymphokine-activated killer activity in vitro. Because rituximab can lyse CD20-bearing cells by antibody-dependent cellular cytotoxicity, adding IL-2 to rituximab might boost its effectiveness. It thus seemed reasonable to study this combination after ASCT. The results of our phase II study are reported herein. PATIENTS AND METHODS Twenty patients with CD20+ NHL who had ASCT were treated. The median time to starting therapy was 79 days (range, 49-100 days) after transplantation. RESULTS The majority of patients reported grade <or= 2 erythema, induration and pain at IL-2 injection sites, flu-like symptoms, and worsening fatigue. Neutropenia that responded to granulocyte colony-stimulating factor was the most common grade 3/4 toxicity, seen in 45% of patients. There were no treatment-related deaths. Eighteen of 20 patients remain alive in complete remission, with a median follow-up of 55.5 months (range, 17-64 months). CONCLUSION Interleukin-2/rituximab can be administered after ASCT with manageable toxicity. A randomized trial is under way to address whether this combination therapy is beneficial to patients with NHL who have had ASCT.
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Affiliation(s)
- Leona A Holmberg
- Clinical Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Aggarwal C, Gupta S, Vaughan WP, Saylors GB, Salzman DE, Katz RO, Nance AG, Tilden AB, Carabasi MH. Improved Outcomes in Intermediate- and High-Risk Aggressive Non-Hodgkin Lymphoma after Autologous Hematopoietic Stem Cell Transplantation Substituting Intravenous for Oral Busulfan in a Busulfan, Cyclophosphamide, and Etoposide Preparative Regimen. Biol Blood Marrow Transplant 2006; 12:770-7. [PMID: 16785066 DOI: 10.1016/j.bbmt.2006.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 03/29/2006] [Indexed: 11/15/2022]
Abstract
Forty-nine patients with intermediate- and high-risk aggressive non-Hodgkin lymphoma underwent autologous hematopoietic stem cell transplantation (autoHSCT) using the regimen of busulfan (Bu), cyclophosphamide (Cy), and etoposide (E) that was originally developed for allogeneic HSCT. Eighteen patients treated before 1999 received Cy 2.5 g/m2 on days -3 to -2 and E 1800 mg/m2 on day -3 after oral (PO) administration of Bu 1 mg/kg every 6 hours x 4 days for a total of 16 doses beginning on day -7. After April 1999, 31 patients similar in all pretransplantation risk assessments received the same regimen except that intravenous (IV) Bu was substituted for PO Bu and pharmacokinetic-directed (PKD) dosing was attempted to achieve an area under the concentration time curve of 1000-1500 micromol/min for each dose. Nonrelapse mortality was 28% for PO Bu patients versus 3% for the IV PKD group (P = .01, chi-square test). Actuarial 5-year overall survivals were 28% for patients who received the PO Bu regimen and 58% for patients who received the IV Bu regimen (P = .010, log-rank test), and progression-free survivals were 17% and 50%, respectively (P = .008, log-rank test). After substitution of PKD IV Bu in the BuCyE regimen, we observed lower nonrelapse mortality with increased overall and progression-free survivals in patients with intermediate- and high-risk aggressive non-Hodgkin lymphoma who underwent autoHSCT.
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Affiliation(s)
- Charu Aggarwal
- Department of Internal Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Ferrara F, Viola A, Copia C, Schiavone EM, Celentano M, Pollio F, D'Amico MR, Palmieri S. Therapeutic results in patients with relapsed diffuse large B cell Non-Hodgkin's lymphoma achieving complete response only after autologous stem cell transplantation. Hematol Oncol 2006; 24:73-7. [PMID: 16550628 DOI: 10.1002/hon.773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Forty patients with relapsed diffuse large B cell lymphoma (DLBCL) autografted in partial response (PR) (n = 23) or in refractory relapse (RR) (n = 17) achieved complete remission (CR) after autologous stem cell transplantation (ASCT). Salvage treatment consisted of ifosphamide, epirubicin and etoposide (IEV) in 33 patients and Cisplatinum, ARA-C and dexamethasone (DHAP) in 7 patients. All PR and 8 RR patients were conditioned with BEAM, while 9 RR cases received the BCV regimen. There were no significant differences between the two groups as age, serum LDH, duration of CR1 and IPI at relapse are concerned. Relapse rate after ASCT was 39% in PR group as opposed to 88% in RR group (p = 0.003). Median relapse free survival from ASCT was 6 months for RR patients as opposed to 34 months for PR patients (p = 0.003); median overall survival from ASCT was 10 months for RR subset as opposed to not reached for RR subgroup (p = 0.001). These data demonstrate that CR achieved after ASCT in DLBCL patients who are refractory to previous salvage therapy does not result in long-term disease control. Alternative preparative regimens, allogeneic SCT and/or monoclonal antibodies in the post-ASCT phase should be considered for RR patients despite CR achievement.
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MESH Headings
- Disease-Free Survival
- Female
- Humans
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Recurrence
- Retrospective Studies
- Stem Cell Transplantation
- Survival Analysis
- Transplantation, Autologous
- Treatment Outcome
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Affiliation(s)
- Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, A. Cardarelli Hospital, Naples, Italy.
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Abstract
The ability to predict clinical outcomes is essential to accurate medical decision analysis. Many accepted bone marrow transplant related prognostic variables are derived from data that is over 20-years old and may or may not be applicable to current medical practice. This report reviews both older data concerning bone marrow transplantation prognostic factors as well as more current reports. In addition to pretransplant variables, this review examines easily measured post-transplant variables that may affect prognosis, as well as data concerning the cellular component of the infused graft in both allogeneic and autologous transplantation.
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Affiliation(s)
- Brian J Bolwell
- Department of Hematology and Medical Oncology, Taussig Cancer Center and Transplant Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Forman SJ. Innovations in autologous transplantation for hematologic malignancy. Biol Blood Marrow Transplant 2005; 11:28-33. [PMID: 15682173 DOI: 10.1016/j.bbmt.2004.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Stephen J Forman
- Division of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
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Robertson MJ, Chang HC, Pelloso D, Kaplan MH. Impaired interferon-gamma production as a consequence of STAT4 deficiency after autologous hematopoietic stem cell transplantation for lymphoma. Blood 2005; 106:963-70. [PMID: 15817683 PMCID: PMC1895167 DOI: 10.1182/blood-2005-01-0201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Production of interferon gamma (IFN-gamma) is critical for optimal antitumor immunotherapy in several preclinical animal models. Interleukin-12 (IL-12)-induced IFN-gamma production is markedly defective after autologous stem cell transplantation. Quantitative deficiency in CD4 T cells, relative increase in CD25+CD4+ T cells, and bias toward T helper 2 (Th2) differentiation are not the primary mechanisms of defective IFN-gamma production. IL-12 receptor beta1 (IL-12Rbeta1) and IL-12Rbeta2 are expressed at equivalent or higher levels on posttransplantation patient peripheral blood mononuclear cells (PBMCs) as compared with control PBMCs. IL-12-induced tyrosine phosphorylation of signal transducer and activator of transcription 4 (STAT4) was undetectable or barely detectable in posttransplantation patient PBMCs, whereas IL-4-induced tyrosine phosphorylation of STAT6 did not differ in posttransplantation patient and control PBMCs. Levels of STAT4 protein were decreased by 97% in posttransplantation patient PBMCs. Levels of STAT4 mRNA were also significantly decreased in posttransplantation patient PBMCs. Incubation with IL-12 and IL-18 in combination partially reversed the defective IFN-gamma production by posttransplantation patient PBMCs. IFN-gamma production in response to IL-12 plus IL-18 did not require increased expression of STAT4 but was dependent on the activity of p38 mitogen-activated protein kinase (MAPK). These results indicate that defective IFN-gamma production is due to an intrinsic deficiency in STAT4 expression by posttransplantation patient lymphocytes and suggest strategies for circumventing this deficiency in cancer immunotherapy.
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Affiliation(s)
- Michael J Robertson
- Bone Marrow and Stem Cell Transplantation Program, Indiana University Medical Center, 1044 W Walnut St, Rm R4-202, Indianapolis, IN 46202, USA.
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Recent publications in hematological oncology. Hematol Oncol 2004; 22:73-84. [PMID: 15515243 DOI: 10.1002/hon.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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