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Sellner L, Boumendil A, Finel H, Choquet S, de Rosa G, Falzetti F, Scime R, Kobbe G, Ferrara F, Delmer A, Sayer H, Amorim S, Bouabdallah R, Finke J, Salles G, Yakoub-Agha I, Faber E, Nicolas-Virelizier E, Facchini L, Vallisa D, Zuffa E, Sureda A, Dreger P. Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT. Bone Marrow Transplant 2016; 51:212-218. [PMID: 26569093 DOI: 10.1038/bmt.2015.273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022]
Abstract
Clinical information about thiotepa-based autologous stem cell transplantation (auto-SCT) outside the primary central nervous system lymphoma (PCNSL) field is sparse. In this registry-based retrospective study, we evaluated potential risks and benefits of thiotepa-based preparative regimens compared with BEAM (carmustine, etoposide, cytarabine, melphalan) in auto-SCT for diffuse large B-cell lymphoma (DLBCL, excluding PCNSL), follicular lymphoma (FL) or Hodgkin lymphoma (HL). A total of 14 544 patients (589 thiotepa and 13 955 BEAM) met the eligibility criteria, and 535 thiotepa- and 1031 BEAM-treated patients were matched in a 1:2 ratio for final comparison. No significant differences between thiotepa and BEAM groups for any survival end point were identified in the whole sample or disease entity subsets. For a more detailed analysis, 47 TEAM (thiotepa, etoposide, cytarabine, melphalan)-treated patients were compared with 75 matched BEAM patients with additional collection of toxicity data. Again, there were no significant differences between the two groups for any survival end point. In addition, the frequency of common infectious and non-infectious complications including secondary malignancies was comparable between TEAM and BEAM. These results indicate that thiotepa-based high-dose therapy might be a valuable alternative to BEAM in DLBCL, HL and FL. Further evaluation by prospective clinical trials is warranted.
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Affiliation(s)
- L Sellner
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - A Boumendil
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - H Finel
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - S Choquet
- Department of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - R Scime
- Department of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - G Kobbe
- University Hospital Düsseldorf, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | | | - A Delmer
- Service d'Hématologie Clinique, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - H Sayer
- Department of Hematology and Oncology, Helios Hospital Erfurt, Erfurt, Germany
| | - S Amorim
- APHP, Hopital Saint-louis, Hemato-Oncology Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - R Bouabdallah
- Hematology Department, Paoli Calmettes Institute, Marseille Aix-Marseille University, Marseille, France
| | - J Finke
- Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - G Salles
- Hematologie, Hospices Civils de Lyon and Université Claude Bernard Lyon-1, Pierre Bénite, France
| | - I Yakoub-Agha
- LIRIC-U995, Hematology Department and Hematopoietic Stem Cell Transplantation Unit, University-Hospital of Lille, Lille, France
| | - E Faber
- Department of Hemato-Oncology, Faculty Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - L Facchini
- Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - D Vallisa
- Hematology Unit, Ospedale Civile, Piacenza, Italy
| | - E Zuffa
- Hematology Unit, S Maria delle Croci Hospital, Ravenna, Italy
| | - A Sureda
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - P Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
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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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Fenske TS, Kahl BS, Eickhoff J, Mitchell TL, Smith EP, Atkinson E, McCoy AG, Eckstein L, Flynn B, McMannes J, Howard S, Longo WL. Excessive toxicity of the high dose thiotepa and etoposide regimen when combined with radiation: Long-term autologous transplantation experience in follicular and mantle cell lymphoma. Leuk Lymphoma 2009; 46:1441-8. [PMID: 16194889 DOI: 10.1080/10428190500144656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We recently described a novel thiotepa plus etoposide high-dose therapy (HDT) conditioning regimen for aggressive histology non-Hodgkin's lymphoma (NHL) that had low regimen-related toxicity (RRT) and an efficacy rate comparable to other NHL HDT regimens. In this report, we describe the UW experience with the addition of total body irradiation (TBI) and pre-transplant involved-field radiation (IFRT) to the thiotepa + etoposide HDT regimen. Between 1992 and 1999, 28 patients with indolent or mantle cell lymphoma were treated on this protocol. With a median follow-up of 64 mo, the median event-free survival (EFS) was 24 months, and the median overall survival (OS) had not been reached. The median number of grade 3 - 4 non-hematologic toxicities was five. There were five deaths (18%) in the first three months after HDT due to RRT. In contrast, the thiotepa + etoposide conditioning regimen (without TBI or IFRT) given to 65 intermediate grade NHL patients resulted in only one treatment-related death and considerably fewer grade 3 - 4 toxicities. Given the relatively short EFS in this cohort of indolent NHL patients, we conclude that the combination of IFRT and TBI plus thiotepa and etoposide resulted in a HDT regimen with excessive toxicity and this protocol was closed at our institution.
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Affiliation(s)
- Timothy S Fenske
- Section of Hematology and Bone Marrow Transplantation, Department of Internal Medicine, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA
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