1
|
Benedetti E, Traverso G, Pucci G, Morganti R, Bramanti E, Cavallo F, Capochiani E, De Maria M, Ricchiuto V, Stella MS, Galimberti S. Prospective study on the impact of BEAM versus FEAM conditioning on occurrence of neutropenic enterocolitis and on transplant outcome in lymphoma patients. Front Oncol 2024; 14:1369601. [PMID: 38803538 PMCID: PMC11128601 DOI: 10.3389/fonc.2024.1369601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) are a widely used high-dose chemotherapy regimen for autologous stem cell transplantation transplant (ASCT) in lymphoid malignancies. During BCNU shortages, some centers switched to fotemustine-substituted BEAM (FEAM). Neutropenic enterocolitis (NEC) is a life-threatening complication occurring after intestinal mucosa damage related to intensive chemotherapy. NEC mortality may be up to 30%-50%. In our study, we compared NEC incidence, symptoms, mortality, and transplant outcome in terms of overall survival (OS) and progression-free survival (PFS) in the BEAM vs. FEAM groups. Furthermore, we compared the cost of hospitalization of patients who did vs. patients who did not experience a NEC episode (NECe). Methods A total of 191 patients were enrolled in this study (N = 129 and N = 62 were conditioned with BEAM and FEAM, respectively). All patients received bed-side high-resolution ultrasound (US) for NEC diagnosis. Results and discussion NEC incidence and NEC-related mortality were similar in the BEAM and FEAM groups (31% and 40.3%, p = 0.653, and 5% and 8%, p = 0.627, respectively). At a median follow-up of 116 months, no difference was noted between BEAM vs. FEAM groups in terms of OS and PFS (p = 0.181 and p = 0.978, respectively). BEAM appeared equivalent to FEAM in terms of NEC incidence and efficacy. The high incidence of NEC and the low mortality is related to a timely US diagnosis and prompt treatment. US knowledge in NEC diagnosis allows to have comparable days of hospitalization of patients NECpos vs. patients NECneg. The cost analysis of NECpos vs. NECneg has been also performed.
Collapse
Affiliation(s)
- Edoardo Benedetti
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Viale delle Milizie 9 00195 Roma, Italian School of Basic and Emergency Ultrasound Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Pisa, Italy
| | - Ginevra Traverso
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulia Pucci
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emilia Bramanti
- Institute of Chemistry of Organo Metallic Compounds (ICCOM), Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Federica Cavallo
- Division of Hematology U, University Hospital Azienda Ospedaliero Universitaria (AOU) “Città della Salute e della Scienza”, Turin, Italy
- Division of Hematology U, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Torino, Italy
| | - Enrico Capochiani
- Hematology Unit, Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Livorno, Italy
| | - Maurizio De Maria
- Hematology Unit, Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Livorno, Italy
| | - Vittorio Ricchiuto
- Dipartimento di Tecnologie Sanitarie Ente di Supporto Tecnico Amministrativo Regionale (ESTAR), Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Massimo Salvatore Stella
- Viale delle Milizie 9 00195 Roma, Italian School of Basic and Emergency Ultrasound Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Pisa, Italy
| | - Sara Galimberti
- Hematology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
2
|
Koresawa-Shimizu R, Suzuki R, Uehara Y, Hiramoto N, Sawa M, Fukuda T, Kataoka K, Kanda Y, Oyake T, Kubota Y, Uchida N, Yano S, Kobayashi H, Tanaka J, Atsuta Y, Kondo E. Comparison of MEAM, MCEC and LEED high-dose chemotherapy followed by autologous stem cell transplantation in relapsed/refractory diffuse large B-cell lymphoma: data from the Japan Society for Hematopoietic and Cellular Therapy Registry. Bone Marrow Transplant 2024; 59:125-127. [PMID: 37805626 DOI: 10.1038/s41409-023-02118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Affiliation(s)
| | - Ritsuro Suzuki
- Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan
| | - Yasufumi Uehara
- Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kokura, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tatsuo Oyake
- Division of Hematology and Oncology, Iwate Medical University, Iwate, Japan
| | - Yasushi Kubota
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan
| | - Shingo Yano
- Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagoya, Japan
| | - Eisei Kondo
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan.
| |
Collapse
|
3
|
Liu H, Zou H, Shan D, Liu W, Huang W, Sui W, Deng S, Wang T, Lv R, Fu M, Xu Y, Yi S, An G, Zhao Y, Qiu L, Zou D. Gemcitabine-based conditioning compared to BEAM/BEAC conditioning prior to autologous stem cell transplantation for non-Hodgkin lymphoma: No difference in outcomes. Cancer Med 2024; 13:e6965. [PMID: 38348996 PMCID: PMC10831922 DOI: 10.1002/cam4.6965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains an effective treatment for non-Hodgkin lymphoma (NHL). The limited availability of carmustine has prompted the exploration of novel alternative conditioning regimens. This study aimed to compare the efficacy and safety profile of GBM/GBC (gemcitabine, busulfan, and melphalan or cyclophosphamide) conditioning compared with the standard BEAM/BEAC regimens (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide) for ASCT in patients with NHL. METHODS A retrospective analysis was conducted on 231 NHL patients, who underwent ASCT from October 2010 to October 2021 at the Institute of Hematology & Blood Disease Hospital, including both first-line and salvage settings. This resulted in the inclusion of 112 patients in the GBM/GBC arm and 92 in the BEAM/BEAC arm. Propensity score matching was employed to validate the results. RESULTS Disease subtype distribution was similar between the GBM/GBC and BEAM/BEAC groups, with diffuse large B-cell lymphoma being the most common (58.9% vs. 58.7%), followed by PTCL (17.0% vs. 18.5%) and MCL (14.3% vs. 14.1%). At 3 months post-ASCT, complete response (CR) rates were comparable (GBM/GBC 93.5% vs. BEAM/BEAC 91.1%; p = 0.607). The 4-year progression-free survival (78.4% vs. 82.3%; p = 0.455) and 4-year overall survival (88.1% vs. 87.7%; p = 0.575) were also similar. Both groups exhibited low non-relapse mortality at 4 years (GBM/GBC 1.8% vs. BEAM/BEAC 3.5%; p = 0.790) with no transplant-related mortalities reported. The GBM/GBC cohort demonstrated a higher incidence of grade 3/4 oral mucositis and hepatic toxicity, whereas the BEAM/BEAC group had more frequent cases of bacteremia or sepsis (13 cases vs. 5 in GBM/GBC). CONCLUSIONS The GBM/GBC regimen is effective and well-tolerated, offering outcomes that are highly comparable to those in NHL patients conditioned with BEAM/BEAC, as demonstrated in a prognostically matched cohort.
Collapse
Affiliation(s)
- Huimin Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Hesong Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Dandan Shan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Wenyang Huang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Tingyu Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Rui Lv
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Mingwei Fu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Yaozhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell EcosystemInstitute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
- Tianjin Institutes of Health ScienceTianjinChina
| |
Collapse
|
4
|
Plante MÉ, Feng X, Boudreault JS. Single-center retrospective study assessing the efficacy and safety of BeEAM (bendamustine, etoposide, cytarabine, melphalan) as conditioning regimen for autologous hematopoietic stem cell transplantation. Leuk Lymphoma 2023; 64:1234-1242. [PMID: 37154396 DOI: 10.1080/10428194.2023.2203790] [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: 01/15/2023] [Revised: 03/01/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Abstract
One of the most widely accepted conditioning regimens for hematopoietic stem cell transplantation (HSCT) is BEAM (carmustine, etoposide, cytarabine, melphalan). However, a recent increase in the cost of carmustine has limited its use bringing our institution to replace carmustine with bendamustine. This observational retrospective single-center study aims to report the efficacy and safety of the BeEAM regimen. 55 patients with diffuse large B-cell lymphoma (47%), Hodgkin lymphoma (25%), mantle cell lymphoma (25%), or follicular lymphoma (2%) were included. Progression-free survival (PFS) at 24 months was 75% and overall survival (OS) was 83%. Treatment-related mortality was 4%. The most common adverse effects were febrile neutropenia (98%), mucositis (72%) and colitis (60%). Our study demonstrated excellent efficacy of the BeEAM regimen. However, the toxicity profile of BeEAM significantly varies from one study to another, and guidelines suggesting optimal dose of bendamustine and supportive care are currently lacking.
Collapse
Affiliation(s)
- Marie-Élaine Plante
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
| | - Xue Feng
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Levis M, Campbell BA, Matrone F, Grapulin L, Di Russo A, Buglione M, Iamundo De Cumis I, Simontacchi G, Ciammella P, Magli A, Pascale G, Meregalli S, MacManus M, Fanetti G, De Felice F, Furfaro G, Ciccone G, Ricardi U. Peritransplant Radiation Therapy in Patients With Refractory or Relapsed Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplant: Long-Term Results of a Retrospective Study of the Fondazione Italiana Linfomi. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00165-7. [PMID: 36822373 DOI: 10.1016/j.ijrobp.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE In this multicenter collaboration, we report real-world data in the largest published series of long-term outcomes for patients with relapsed/refractory (r/r) Hodgkin lymphoma (HL) treated with peritransplant radiation therapy (pt-RT) and high-dose chemotherapy with autologous stem cell transplant (ASCT). METHODS AND MATERIALS We conducted a retrospective analysis including data from 12 institutions. Eligibility required histologic diagnosis of HL, receipt of ASCT plus pt-RT between 2004 and 2014 for r/r HL, and age ≥18 years at the time of ASCT. All patients received salvage chemotherapy for maximum debulking before ASCT. Metabolic responses were scored according to the Lugano Classification. The primary endpoint was overall survival (OS). Univariate and multivariate Cox proportional hazards were calculated to estimate the effect of covariates on patients' outcome. RESULTS One hundred thirty-one patients were eligible: 68 were male (52%), and median age at ASCT was 32 years (range, 18-70). At the time of diagnosis with r/r HL, 92 patients (70%) had limited (stage I-II) disease, and 10 patients (8%) had bulky disease. Pt-RT was given pre-ASCT in 32 patients (24%) and post-ASCT in 99 (76%); median prescribed dose was 30.6 Gy (range, 20-44 Gy). With median follow-up of 60 months, 3- and 5-year OS were 84% and 77%, while 3- and 5-year progression-free survival were 75% and 72%, respectively. On univariate and multivariate analysis, advanced stage at relapse (hazard ratio [HR], 2.18; P = .04), irradiation of >3 sites (HR, 3.69; P = .01), and incomplete metabolic response after salvage chemotherapy (HR, 2.24; P = .01) had a negative effect on OS. The sequencing of pt-RT (pre- vs post-ASCT) did not affect outcomes. CONCLUSIONS Overall, the addition of pt-RT to ASCT for patients with r/r HL is associated with very good outcomes. Limited relapsed disease with ≤3 sites involved and achievement of complete metabolic response after salvage chemotherapy were predictive of more favorable prognosis.
Collapse
Affiliation(s)
- Mario Levis
- Department of Oncology, University of Torino, Torino, Italy.
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Fabio Matrone
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano, Centro di Riferimento Oncologico-Istituto di Ricovero e Cura a Carattere Scientifico (CRO-IRCCS), Aviano, Italy
| | - Lavinia Grapulin
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Anna Di Russo
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Michela Buglione
- Department of Radiation Oncology, University and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Ilenia Iamundo De Cumis
- Department of Radiation Oncology, Oncology Hospital A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, University Hospital of Udine, Udine, Italy
| | - Giuliana Pascale
- Radiotherapy Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Sofia Meregalli
- Radiotherapy Unit, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Giuseppe Fanetti
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano, Centro di Riferimento Oncologico-Istituto di Ricovero e Cura a Carattere Scientifico (CRO-IRCCS), Aviano, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovannino Ciccone
- Clinical Epidemiology, Città della Salute e della Scienza and Centro Prevenzione Oncologica (CPO) Piemonte, Torino, Italy
| | | |
Collapse
|
7
|
Gunes AK, Serin I, Demir I, Sarifakiogullari S, Durusoy SS, Akkurt DM, Ince I, Ozkan G, Cinli TA, Pehlivan M. Comparison of Mitoxantrone-Melphalan and BEAM Conditioning Regimens in Patients with Lymphoma. Hematol Oncol Stem Cell Ther 2022; 15:201-207. [PMID: 33933474 DOI: 10.1016/j.hemonc.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE/BACKGROUND Lymphoma is seen as a highly treatable and curable malignancy with aggressive treatment methods. Efficacy is often limited by toxicity and many patients need alternative treatment strategies as they cannot tolerate existing high cytotoxic approaches. Our aim is to compare BEAM [carmustine (BCNU), etoposide, cytarabine (ARA-C, cytosine arabinoside), and melphalan] and mitoxantrone-melphalan (Mx-Mel) regimens utilized in our patients with a diagnosis of lymphoma who underwent autologous stem cell transplantation (ASCT), and to demonstrate that the Mx-Mel regimen has similar but less toxic results than the BEAM regimen we have been using frequently as standard conditioning regimen. METHODS A total of 101 patients with lymphoma who underwent ASCT were included in our study. The BEAM regimen included BCNU, etoposide, ARA-C, and melphalan. The Mx-Mel regimen included mitoxantrone and melphalan. RESULTS Of 101 patients included in the study, 60 (59.4%) received BEAM and 41 (40.6%) received Mx-Mel (40.6%) conditioning regimen. The median time to neutrophil engraftment was 10 (range: 9-20) days and 12 (range: 9-12) days in the BEAM and Mx-Mel arms, respectively; it was statistically significantly shorter in the BEAM arm (p = .001). CONCLUSION This study demonstrates that the Mx-Mel regimen has similar efficacy and toxicity compared with the BEAM regimen. Although time to neutrophil engraftment was shorter in the BEAM arm, it did not result as significant transplant-related complications between the two regimens. The Mx-Mel regimen is seen as a good alternative with low toxicity and high efficacy.
Collapse
Affiliation(s)
| | - Istemi Serin
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Ilknur Demir
- Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Dervis Murad Akkurt
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
| | - Idris Ince
- Dr. Ersin Aslan Training and Research Hospital, Department of Hematology, Gaziantep, Turkey
| | - Gulkan Ozkan
- Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Tahir Alper Cinli
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Mustafa Pehlivan
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
| |
Collapse
|
8
|
Fernández-Gutiérrez JA, Reyes-Cisneros OA, Litzow MR, Bojalil-Alvarez L, Garcia-Villasenor E, Gómez-Gomez ET, Murrieta-Alvarez I, Gomez-Almaguer D, Gutierrez-Aguirre CH, Karduss-Urueta AJ, Ruiz-Delgado GJ, Ruiz-Arguelles GJ. High dose melphalan is an adequate preparative regimen for autologous hematopoietic stem cell transplantation in relapsed/refractory lymphoma. Hematology 2022; 27:449-455. [PMID: 35413225 DOI: 10.1080/16078454.2022.2059630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION High-dose melphalan (HD-Mel) has been successfully employed in autografting patients with multiple myeloma. An advantage of this regimen is that the total dose of Mel can be delivered in a single day, being particularly useful when non-frozen hematopoietic stem cells are employed in the autograft. MATERIAL AND METHODS All consecutive patients with R/R lymphomas, both HL and NHL studied and treated at two different centers were prospectively included in a study of ASCT employing a single dose of HD-Mel (200 mg/m2). A group of R/R HL or NHL autografted employing BEAM-like preparative regimens was constructed matched by diagnosis and age. The primary endpoint of the study was overall survival (OS), the secondary endpoint was event-free survival (EFS). RESULTS Twenty-five R/R HL/NHL patients were prospectively accrued in the study. There were 8 (32%) females, 13 (52%) patients had at least 1 adverse effect: 7 (28%) developed mucositis, 5 (20%) neutropenic fever, and 6 (24%) grade IV nausea. In the HD-Mel group, median overall survival (OS) was not achieved and OS at 36 months was 71%, the transplant-related mortality being 0%. In the control group, median OS was not achieved and the 36-month OS was 76%, results not statistically significant (p 0.5). The EFS was also similar in both groups (p 0.5). CONCLUSION HD-Mel alone is non-inferior to a BEAM-like regimen as a preparative regimen for autografting patients with R/R HL and NHL. The regimen is adequate to graft persons with non-frozen stem cells.
Collapse
Affiliation(s)
| | | | - Mark R Litzow
- Hematology, Mayo Clinic Minnesota, Rochester, MN, USA
| | | | | | | | | | - David Gomez-Almaguer
- Hematología, Hospital Universitario de Nuevo León "José Eleuterio González", Monterrey, Mexico
| | | | | | | | - Guillermo José Ruiz-Arguelles
- Centro de Hematología y Medicina Interna de Puebla, Universidad Popular Autonoma del Estado de Puebla, Puebla, Mexico
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
BeEAM conditioning regimen is a safe, efficacious and economical alternative to BEAM chemotherapy. Sci Rep 2021; 11:14071. [PMID: 34234243 PMCID: PMC8263771 DOI: 10.1038/s41598-021-93516-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/25/2021] [Indexed: 01/12/2023] Open
Abstract
In many stem cell transplant centres, BCNU, etoposide, cytarabine and melphalan (BEAM) high-dose chemotherapy (HDCT) has been replaced by the more economic and available bendamustine, etoposide, cytarabine, melphalan (BeEAM) regimen. However, there is a paucity of information on the efficacy and safety of BeEAM HDCT. We describe our experience with BeEAM HDCT in terms of safety, efficacy and cost-savings. We compare overall and progression-free survival to a cohort of patients previously transplanted at our institution with the older BEAM regimen. We performed a retrospective chart review of 41 lymphoma patients undergoing BeEAM HDCT at the Royal University Hospital in Saskatoon, Saskatchewan between 2015 and 2019 to elicit regimen safety in the first 100 days post-transplant. Furthermore, we calculated overall and progression-free survival and constructed corresponding Kaplan-Meier curves, comparing the results to a historical cohort of BEAM patients (n = 86). Finally, we conducted an economic analysis using the financials available at our centre's pharmacy. With regards to BeEAM HDCT, we report a 100-day transplant-related mortality of 2.4%. Additionally, we report acceptable rates of typhlitis (27%), grade III-IV mucositis (4.9%) and grade III-IV nephrotoxicity (2.4%). In terms of overall and progression-free survival, we found no statistical difference between BeEAM and BEAM (p = 0.296; 0.762, respectively). Finally, our economic analysis revealed a net savings of $21,200 CAD per transplant when BeEAM is used in replacement of BEAM. The acceptable safety profile of BeEAM and its comparable efficacy to BEAM are encouraging for the perseverance of this cost-effective HDCT regimen.
Collapse
|
11
|
Modified conditioning regimen with idarubicin followed by autologous hematopoietic stem cell transplantation for invasive B-cell non-Hodgkin's lymphoma patients. Sci Rep 2021; 11:4273. [PMID: 33608570 PMCID: PMC7895978 DOI: 10.1038/s41598-021-81944-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 12/28/2020] [Indexed: 12/20/2022] Open
Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) is still a consolidation treatment choice for relapsed/refractory B-cell non-Hodgkin’s lymphoma (NHL) patients and some aggressive B-cell NHL as frontline therapy. Due to the shortage of carmustine, we switched to idarubicin-substituted BEAC (IEAC) conditioning regimen. We retrospectively compared the outcomes of 72 aggressive B-cell NHL patients treated with IEAC or BEAC regimens followed by ASCT as upfront consolidative treatment. The median time to neutrophil and platelet reconstitution showed no difference between IEAC and BEAC groups. IEAC regimen was well tolerated without increase of adverse events. Transplant-related mortality didn’t occur. The overall survival (OS) and progression-free survival (PFS) of IEAC group (33 and 23 months) were a little longer than that of BEAC group (30 and 18 months). However, due to the small sample numbers, there’s no significant difference in OS and PFS between IEAC and BEAC group with DLBCL or MCL. Multivariate analysis showed that AnnArbor staging, IPI score, lactate dehydrogenase level, remission of disease, modified regimen were related with PFS and OS. In conclusion, IEAC regimen was well tolerated and replacement with idarubicin could be an alternative when carmustine was not available.
Collapse
|
12
|
Zavattaro M, Felicetti F, Faraci D, Scaldaferri M, Dellacasa C, Busca A, Dionisi-Vici M, Cattel F, Motta G, Giaccone L, Ghigo E, Arvat E, Lanfranco F, Bruno B, Brignardello E. Impact of Allogeneic Stem Cell Transplantation on Testicular and Sexual Function. Transplant Cell Ther 2020; 27:182.e1-182.e8. [PMID: 33830036 DOI: 10.1016/j.jtct.2020.10.020] [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: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/22/2022]
Abstract
High-dose chemotherapy and radiotherapy, administered as a conditioning regimen before stem cell transplantation, are known to negatively impact testicular function and sexuality. However, to date, only a few studies have simultaneously analyzed the real prevalence of these complications in this clinical setting. Therefore, this study aimed to assess the prevalence of testicular dysfunction and sexual impairment in a cohort of males who underwent allogeneic stem cell transplantation in adulthood. This observational, cross-sectional, single-center study consecutively enrolled 105 subjects on outpatient follow-up. Testicular function and sexuality were evaluated through a hormonal profile (testosterone, follicle-stimulating hormone, luteinizing hormone, and inhibin B) and the IIEF-15 questionnaire, respectively. We found a higher prevalence of hypogonadism (21%), impaired spermatogenesis (87%), and erectile dysfunction (72%) compared with the general population. Chronic graft-versus-host disease, especially of moderate/severe grade, was associated with an increased risk of developing erectile dysfunction (odds ratio, 6.338). Moreover, a high proportion of patients presented with alterations in all domains of sexual function, even after complete clinical remission of hematologic disease. Our data confirm both testicular function and sexuality alterations as frequent complications after allogeneic stem cell transplantation. A multidisciplinary approach is advisable for early diagnosis and adequate treatment.
Collapse
Affiliation(s)
- Marco Zavattaro
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Danilo Faraci
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | - Chiara Dellacasa
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alessandro Busca
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Margherita Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Cattel
- Pharmacy, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giovanna Motta
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luisa Giaccone
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Department of Medical Sciences, University of Turin, Turin, Italy; Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabio Lanfranco
- Andrology Unit, Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Benedetto Bruno
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy.
| |
Collapse
|
13
|
Marchesi F, Capria S, Pedata M, Terrenato I, Ballotta L, Riccardi C, Papa E, Riemma C, Trisolini S, Celentano M, Regazzo G, Ferrara F, Mengarelli A, Picardi A. BEAM conditioning regimen ensures better progression-free survival compared with TEAM but not with FEAM in lymphoma patients undergoing autologous stem cell transplant. Leuk Lymphoma 2020; 61:2238-2241. [PMID: 32419550 DOI: 10.1080/10428194.2020.1765238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Saveria Capria
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | | | - Irene Terrenato
- Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Ballotta
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Cira Riccardi
- Stem Cell Transplant Program of AORN Cardarelli, Naples, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Costantino Riemma
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Silvia Trisolini
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Maria Celentano
- Stem Cell Transplant Program of AORN Cardarelli, Naples, Italy
| | - Giulia Regazzo
- Genomic and Epigenetic Unit, Translational Research Area, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | |
Collapse
|
14
|
Xie Y, Wang X, Leng X, Zheng W, Ping L, Zhang C, Liu W, Deng L, Wu M, Song Y, Zhu J. High-dose chemotherapy followed by autologous stem cell transplantation for patients with refractory/relapsed classical Hodgkin lymphoma: a single center experience from China. Ann Hematol 2020; 99:549-555. [PMID: 31980860 DOI: 10.1007/s00277-019-03812-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
To evaluate the outcomes of refractory/relapsed cHL patients after high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) in Beijing Cancer hospital and to identify the prognostic risk factors. We retrospectively analyzed 115 relapsed/refractory cHL patients who accepted HDCT and ASCT in our cancer center and had complete follow-up data from April 2000 to May 2017. Ages of these 115 patients at ASCT ranged from 14 to 63 (median age 28). Forty-four (38.3%) patients achieved CR and 50 (43.5%) patients achieved PR before ASCT. Thirty-seven (48.7%) patients of those 76 patients who did PET-CT before ASCT had negative PET-CT scans. The median follow-up time was 72 months. A total of 23 patients died in our study. The 5-year OS and PFS rates of all patients after ASCT were 78.7% and 53%, respectively. The 5-year OS rates after ASCT of patients who were in CR or PR or less than PR status before ASCT were 92.8%, 68.2%, and 76.2%, respectively (log-rank = 2.913, p = 0.233). And their 5-year PFS rates after ASCT were 69.2%, 54.2%, and 18.5%, respectively (log-rank = 13.615, p = 0.001). Univariate analysis revealed that ECOG (p = 0.010; hazard ratio = 1.578), disease status before ASCT (CR: p = 0.001; hazard ratio = 0.227) and after ASCT (CR: p < 0.001; hazard ratio = 0.154), and PET-CT results after ASCT (p = 0.023; hazard ratio = 0.438) significantly impact patients' PFS while number of pretransplant salvage chemotherapy (p = 0.037; hazard ratio = 2.521), radiotherapy (p = 0.046; hazard ratio = 0.423), and disease status after ASCT (CR: p = 0.010; hazard ratio = 0.197) significantly affected patients' OS. Multivariate analysis shown only disease status before ASCT (p = 0.002) had significant impact on PFS and disease status after ASCT (p = 0.021) had significant impact on OS. R/R HL patients can still obtain long-term PFS after HDCT and ASCT and disease status before ASCT was the most significant prognostic factor for PFS.
Collapse
Affiliation(s)
- Yan Xie
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaopei Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Leng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wen Zheng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingyan Ping
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chen Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiping Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijuan Deng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuqin Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ju Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
| |
Collapse
|
15
|
Bendamustine-EAM versus BEAM regimen in patients with mantle cell lymphoma undergoing autologous stem cell transplantation in the frontline setting: a multicenter retrospective study from Lymphoma Study Association (LYSA) centers. Bone Marrow Transplant 2020; 55:1076-1084. [PMID: 31953532 DOI: 10.1038/s41409-020-0783-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 11/08/2022]
Abstract
The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) as conditioning regimen prior to autologous stem-cell transplantation (ASCT) remains the standard of care for patients with mantle cell lymphoma (MCL) who are eligible for transplantation. The replacement of carmustine with bendamustine (BeEAM) was described as a promising alternative in non-Hodgkin lymphoma. The aim of this retrospective study was to compare the BeEAM with the BEAM regimen in MCL patients in the frontline setting. Sixty and 108 patients were included in the BeEAM and the BEAM groups, respectively. At 3 years, progression-free survival (PFS) was significantly higher in the BeEAM than in the BEAM group (84% [73-96] vs. 63% [51-79], p = 0.03). The overall survival was not statistically different between the two groups (p = 0.2). In multivariable analysis, BeEAM regimen remained associated with higher PFS (HR = 0.377, 95% CI, 0.146-0.970; p = 0.043). Subgroup analyses in patients treated with prior rituximab-aracytine induction alone showed that BeEAM improved the PFS compared with BEAM regimen (p = 0.04). Despite the high rate of acute renal failure KDIGO III (32%), treatment-related mortality was not increased with the BeEAM regimen. A prospective randomized trial will be necessary to confirm the beneficial effect of the BeEAM regimen in MCL patients undergoing ASCT.
Collapse
|
16
|
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.
Collapse
|
17
|
Strategies to improve outcomes of autologous hematopoietic cell transplant in lymphoma. Bone Marrow Transplant 2018; 54:943-960. [PMID: 30390059 DOI: 10.1038/s41409-018-0378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 11/08/2022]
Abstract
High-dose chemotherapy and autologous hematopoietic cell transplantation (HDT-AHCT) remains an effective therapy in lymphoma. Over the past several decades, HDT with BEAM (carmustine, etoposide, cytarabine, and melphalan) and CBV (cyclophosphamide, carmustine, and etoposide) have been the most frequently used preparatory regimens for AHCT in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). This article reviews alternative combination conditioning regimens, as well as novel transplant strategies that have been developed, to reduce transplant-related toxicity while maintaining or improving efficacy. These data demonstrate that incorporation of maintenance therapy posttransplant might be the best way to improve outcomes.
Collapse
|