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Cabrero M, López-Corral L, Jarque I, de la Cruz-Vicente F, Pérez-López E, Valcárcel D, Sanz J, Espigado I, Ortí G, Martín-Calvo C, de la Serna J, Caballero D. Ofatumumab as part of reduced intensity conditioning in high risk B-cell lymphoma patients: final long-term analysis from a prospective multicenter Phase-II Trial. Bone Marrow Transplant 2024; 59:359-365. [PMID: 38167647 DOI: 10.1038/s41409-023-02171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
Curative potential of allogeneic transplantation (AlloSCT) in high-risk non-Hodgkin lymphoma (NHL) could be enhanced by the integration of Ofatumumab (OFA), a 2nd generation anti-CD20 moAb, due to an antitumor effect and a role over graft-versus-host disease (GVHD). In this phase II trial (NCT01613300), we investigated safety and effectiveness of OFA-based reduced intensity conditioning (RIC). High-risk B-cell NHL patients with chemorrefractory disease or post-autologous SCT relapse were eligible. OFA was added to a standard RIC regimen. Primary endpoint was grade 3-4 aGVHD rate, while secondary endpoints included CR and survival rates. Thirty-three patients were included (median age 51; diffuse large B-cell:68%, HLA-identical donor: 74%). No grade >2 OFA toxicity was observed. Acute GVHD affected 77% of patients (16% grade 3-4). Remarkably, GVHD achieved CR in 75% of patients after first-line treatment. Chronic GVHD, primarily mild or moderate, occurred in 54% of patients. NHL CR rate at day +100 was 81%. Relapses occurred in 7 patients after a median of 3 months. Causes of death were lymphoma progression (5), infections (10), and GVHD (2). At 24 months, progression-free and overall survival rates were 50.1 and 51.6% respectively. OFA-RIC regimen is safe and effective, though acute GVHD remains a significant complication. However, data suggest that OFA could mitigate its severity.
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Affiliation(s)
- Mónica Cabrero
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
| | | | - Isidro Jarque
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Jaime Sanz
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
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2
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Lee C, Lin T, Yao M, Hsiao L, Ko B, Liu C, Chen T. Allogeneic hematopoietic stem cell transplantation for B-cell lymphoma in Taiwan. Cancer Med 2023; 12:21761-21769. [PMID: 38018321 PMCID: PMC10757116 DOI: 10.1002/cam4.6741] [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: 08/07/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered for patients with high-risk B-cell lymphoma and relapsed or refractory disease. This study aimed to analyze the long-term follow-up data of patients who underwent allo-HSCT in Taiwan. This was a retrospective observational study using data from the Taiwan Society of Blood and Marrow Transplantation database. A total of 105 patients who underwent allo-HSCT because of high-risk, relapsed, or refractory disease between 2010 and 2019 were included. Forty-five percent of the patients previously underwent autologous stem cell transplantation (ASCT). The median follow-up duration was 18.6 months. The probability of 3-year progression-free survival and overall survival (OS) was 34.5% and 37%, respectively. The probability of 1-year non-relapse mortality was 31.4%, and the major cause was infection (75.8%). The multivariable analysis showed that not in remission at the time of transplantation and the absence of graft-versus-host disease (GVHD) were factors associated with inferior OS. The probability of 3-year OS in patients with diffuse large B-cell lymphoma who underwent allo-HSCT and allo-HSCT after ASCT was 40.2% and 25.2%, respectively. Allo-HSCT could be a salvage therapeutic option for relapsed or refractory B-cell lymphoma. Complete remission at the time of allo-HSCT and the presence of GVHD are independent variables for overall survival.
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Affiliation(s)
- Chun‐Hui Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung UniversityTainanTaiwan
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Tzu‐Chien Lin
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
- Division of Hematology, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Ming Yao
- Division of Hematology, Department of Internal MedicineNational Taiwan University Hospital, College of MedicineTaipeiTaiwan
| | - Liang‐Tsai Hsiao
- Division of Hematology, Department of Internal MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Bor‐Sheng Ko
- Division of Hematology, Department of Internal MedicineNational Taiwan University Hospital, College of MedicineTaipeiTaiwan
- Department of Hematological OncologyNational Taiwan University Cancer CenterTaipeiTaiwan
| | - Chia‐Jen Liu
- Division of Hematology, Department of Internal MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Emergency and Critical Care Medicine, School of MedicineNational Yang‐Ming Chiao Tung UniversityTaipeiTaiwan
| | - Tsai‐Yun Chen
- Division of Hematology, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
- Center for Cell TherapyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
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3
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Castagna L, Bono R, Tringali S, Sapienza G, Santoro A, Indovina A, Tarantino V, Di Noto L, Maggio A, Patti C. The place of allogeneic stem cell transplantation in aggressive B-cell non-Hodgkin lymphoma in the era of CAR-T-cell therapy. Front Med (Lausanne) 2022; 9:1072192. [PMID: 36561713 PMCID: PMC9763323 DOI: 10.3389/fmed.2022.1072192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Chimeric antigen receptor T (CAR-T) cells are a treatment option for patients with relapse/refractory (R/R) non-Hodgkin lymphoma (NHL), acute lymphoid leukemia and multiple myeloma. To date, diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), follicular lymphoma (FL), and chronic lymphocytic leukemia (CLL) have been successfully treated with CAR-T cells directed against the CD19 antigen. However, when R/R disease persists after several treatment lines, patients with these diseases are often referred to transplantation centres to receive allogeneic stem cell transplantation (ALLO-SCT). ALLO-SCT and CAR-T cells share mechanism of actions, inducing immune effects of T-cells (and other cells after transplantation) against lymphoma cells, but they differ in several other characteristics. These differences justify unique positioning of each therapy within treatment algorithms. In this paper, we analyzed the results obtained after ALLO-SCT and CAR-T-cell therapy in patients with aggressive lymphomas (large B-cell lymphoma and MCL) to identify the ideal scenarios in which these 2 immunological therapies should be employed.
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Affiliation(s)
- Luca Castagna
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, Palermo, Italy,*Correspondence: Luca Castagna
| | - Roberto Bono
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | | | | | - Alessandra Santoro
- Onco-Hematology and Cell Manipulation Laboratory Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | | | - Vittoria Tarantino
- Onco-Hematology Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Laura Di Noto
- Transfusional and Transplantation Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Aurelio Maggio
- Campus of Hematology Franco and Piera Cutino, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Caterina Patti
- Onco-Hematology Unit, Azienda Ospedaliera Riunita (AOR) Villa Sofia-Vincenzo Cervello, Palermo, Italy
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4
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Chow VA, Cassaday RD, Gooley TA, Smith SD, Sandmaier BM, Green DJ, Orozco JJ, Tuazon SA, Matesan M, Fisher DR, Maloney DG, Press OW, Gopal AK. Megadose 90Y-ibritumomab tiuxetan prior to allogeneic transplantation is effective for aggressive large B-cell lymphoma. Blood Adv 2022; 6:37-45. [PMID: 34649272 PMCID: PMC8753215 DOI: 10.1182/bloodadvances.2021005056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) can be curative for relapsed or refractory B-cell lymphomas (BCLs), although outcomes are worse in aggressive disease, and most patients will still experience relapse. Radioimmunotherapy using 90Y-ibritumomab tiuxetan can induce disease control across lymphoma subtypes in a dose-dependent fashion. We hypothesized that megadoses of 90Y-ibritumomab tiuxetan with reduced-intensity conditioning could safely produce deeper remissions in aggressive BCL further maintained with the immunologic effect of allo-HCT. In this phase 2 study, CD20+ BCL patients received outpatient 90Y-ibritumomab tiuxetan (1.5 mCi/kg; maximum, 120 mCi), fludarabine, and then 2 Gy total body irradiation before HLA-matched allo-HCT. Twenty patients were enrolled after a median of 4.5 prior lines of therapy, including 14 with prior autologous transplant and 4 with prior anti-CD19 chimeric T-cellular therapy. A median 90Y-ibritumomab tiuxetan activity of 113.6 mCi (range, 71.2-129.2 mCi) was administered, delivering a median of 552 cGy to the liver (range, 499-2411 cGy). The estimated 1- and 5-year progression-free survival was 55% (95% confidence interval [CI], 31-73) and 50% (95% CI, 27-69) with a median progression-free survival of 1.57 years. The estimated 1- and 5-year overall survival was 80% (95% CI, 54-92) and 63% (95% CI, 38-81) with a median overall survival of 6.45 years. Sixteen patients (80%) experienced grade 3 or higher toxicities, although nonrelapse mortality was 10% at 1 year. No patients developed secondary acute myeloid leukemia/myelodysplastic syndrome. Megadose 90Y-ibritumomab tiuxetan, fludarabine, and low-dose total body irradiation followed by an HLA-matched allo-HCT was feasible, safe, and effective in treating aggressive BCL, exceeding the prespecified end point while producing nonhematologic toxicities comparable to those of standard reduced-intensity conditioning regimens.
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Affiliation(s)
- Victor A. Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Ryan D. Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology, Department of Medicine
| | - Theodore A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen D. Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Brenda M. Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Johnnie J. Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Sherilyn A. Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Manuela Matesan
- Division of Nuclear Medicine, Department of Radiology, University of Washington, Seattle, WA; and
| | | | - David G. Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine
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5
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Allogeneic Transplant and CAR-T Therapy After Autologous Transplant Failure in DLBCL: A Noncomparative Cohort Analysis. Blood Adv 2021; 6:486-494. [PMID: 34673903 PMCID: PMC8791562 DOI: 10.1182/bloodadvances.2021005788] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Allogeneic transplant (alloHCT) and chimeric antigen receptor modified (CAR) T-cell therapy are potentially cuarative options of diffuse large B-cell lymphoma (DLBCL) relapsing after an autologous (auto) HCT. While the Center for International Blood and Marrow Transplant Research (CIBMTR) prognostic model can predict outcomes of alloHCT in DLBCL after autoHCT failure, corresponding models of CAR-T treatment in similar patient populations are not available. In this noncomparative registry analysis we report outcomes of DLBCL patients (≥18 years), undergoing a reduced intensity alloHCT or CAR-T therapy during 2012-2019, after a prior auto-HCT failure, and apply CIBMTR prognostic model to CAR-T recipients. 584 patients were included. The 1-year relapse, non-relapse mortality, overall survival (OS) and progression-free survival (PFS) for CAR-T treatment after autoHCT failure were were 39.5%, 4.8%, 73.4% and 55.7%, respectively. The corresponding rates in alloHCT cohort were 26.2%, 20.0%, 65.6% and 53.8%, respectively. The 1-year OS of alloHCT recipients classified as low-, intermediate- and high/very high-risk groups according to the CIBMTR prognostic score was 73.3%, 59.9%, and 46.3, respectively (p=0.002). The corresponding rates for low-, intermediate- and high/very high-risk CAR-T patients were 88.4%, 76.4%, and 52.8%, respectively (p<0.001). This registry analysis shows that both CAR-T and alloHCT can provide durable remissions in subset of DLBCL patients relapsing after a prior autoHCT. The simple, CIBMTR prognostic score can be used to identify patients at high risk of treatment failure after either procedure. Evaluation of novel relapse mitigations strategies after cellular immunotherapies are warranted in these high risk patients.
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Wullenkord R, Berning P, Niemann AL, Wethmar K, Bergmann S, Lutz M, Schliemann C, Mesters R, Keßler T, Schmitz N, Berdel WE, Lenz G, Stelljes M. The role of autologous stem cell transplantation (ASCT) in aggressive B-cell lymphomas: real-world data from a retrospective single-center analysis. Ann Hematol 2021; 100:2733-2744. [PMID: 34477953 PMCID: PMC8510902 DOI: 10.1007/s00277-021-04650-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 12/01/2022]
Abstract
Patients with high-risk or relapsed aggressive B-cell lymphomas are characterized by poor prognosis. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) can induce durable remissions in these patients and is potentially curative. Two hundred forty-seven patients with aggressive B-cell lymphomas treated with high-dose chemotherapy and ASCT, either as consolidation after first-line therapy or after salvage therapy for relapsed disease, between 2002 and 2019 at the University Hospital Muenster, were analyzed. The median follow-up of surviving patients was 36 months (range 0–163). Progression-free survival (PFS) and overall survival (OS) after 3 years was 63% and 68%, respectively. After ASCT, 28% of all patients experienced a relapse. The cumulative incidence of non-relapse mortality at day 100 after ASCT was 4%. Multivariate analysis identified remission status at ASCT, age at ASCT, and the numbers of infused CD34+ cells as independent prognostic factors for both PFS and OS. Patients with mantle cell lymphoma (MCL) or primary CNS lymphoma (PCNSL) treated with ASCT in first-line had a superior OS and PFS when compared to patients treated with ASCT in relapsed disease. For patients with diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), early relapse (< 12 months) after first-line therapy showed a trend towards an inferior PFS and OS. Deaths after ASCT were predominantly caused by lymphoma relapse and/or progression (64%) or due to infections (23%). In conclusion, high-dose chemotherapy followed by ASCT in the era of novel targeted agents remains a feasible and effective approach for patients with high-risk or relapsed aggressive B-cell lymphomas. Remission status and age at ASCT, and the number of infused stem cells were of prognostic relevance.
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Affiliation(s)
- Ramona Wullenkord
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Philipp Berning
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Anna-Lena Niemann
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Klaus Wethmar
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Sarah Bergmann
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Mathias Lutz
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Rolf Mesters
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Torsten Keßler
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Norbert Schmitz
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Matthias Stelljes
- Department of Medicine A, Hematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
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7
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Saad A, de Lima M, Anand S, Bhatt VR, Bookout R, Chen G, Couriel D, Di Stasi A, El-Jawahri A, Giralt S, Gutman J, Ho V, Horwitz M, Hsu J, Juckett M, Kharfan-Dabaja MA, Loren A, Meade J, Mielcarek M, Moreira J, Nakamura R, Nieto Y, Roddy J, Satyanarayana G, Schroeder M, Tan CR, Tzachanis D, Burn J, Pluchino L. Hematopoietic Cell Transplantation, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 18:599-634. [PMID: 32519831 DOI: 10.6004/jnccn.2020.0021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hematopoietic cell transplantation (HCT) involves the infusion of hematopoietic progenitor cells into patients with hematologic disorders with the goal of re-establishing normal hematopoietic and immune function. HCT is classified as autologous or allogeneic based on the origin of hematopoietic cells. Autologous HCT uses the patient's own cells while allogeneic HCT uses hematopoietic cells from a human leukocyte antigen-compatible donor. Allogeneic HCT is a potentially curative treatment option for patients with certain types of hematologic malignancies, and autologous HCT is primarily used to support patients undergoing high-dose chemotherapy. Advances in HCT methods and supportive care in recent decades have led to improved survival after HCT; however, disease relapse and posttransplant complications still commonly occur in both autologous and allogeneic HCT recipients. Allogeneic HCT recipients may also develop acute and/or chronic graft-versus-host disease (GVHD), which results in immune-mediated cellular injury of several organs. The NCCN Guidelines for Hematopoietic Cell Transplantation focus on recommendations for pretransplant recipient evaluation and the management of GVHD in adult patients with malignant disease.
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Affiliation(s)
- Ayman Saad
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Marcos de Lima
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | | | | | - Vincent Ho
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | - Alison Loren
- Abramson Cancer Center at the University of Pennsylvania
| | - Javier Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Marco Mielcarek
- Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance
| | - Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yago Nieto
- The University of Texas MD Anderson Cancer Center
| | - Juliana Roddy
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Mark Schroeder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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Impact of Rituximab and Host/Donor Fc Receptor Polymorphisms after Allogeneic Hematopoietic Cell Transplantation for CD20 + B Cell Malignancies. Biol Blood Marrow Transplant 2020; 26:1811-1818. [PMID: 32693210 DOI: 10.1016/j.bbmt.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
We previously reported a 24% 1-year relapse rate in 93 older or medically unfit patients with CD20+ B cell malignancies after allogeneic hematopoietic cell transplantation (HCT) with low-intensity conditioning. The current prospective study tested the hypothesis that disease relapse could be reduced and overall survival (OS) improved by peritransplantation administration of rituximab (RTX). Sixty-three patients received RTX (375 mg/m2/day) on days -3, +10, +24, and +38 along with 2 to 3 Gy total body irradiation with or without fludarabine (30 mg/m2 for 3 days). Median RTX levels of >25 μg/mL were achieved through day +84 after transplantation, but RTX level was not correlated with relapse or graft-versus-host disease (GVHD). HCT recipients with F/F and V/F FCγRIIIa polymorphisms showed a trend toward a higher relapse rate compared with those with V/V polymorphism (P= .15). No difference in outcome was found based on V/V donor pairing. Five-year relapse rates were similar between RTX-treated patients and historical controls (32% versus 28%; P = .94). RTX-treated patients had greater 5-year OS (47% versus 38%; P = .13) and progression-free survival (41% versus 32%; P = .12) compared with historical controls who underwent HCT without RTX, although the difference was not statistically significant. The incidence of acute GVHD was similar in the 2 groups (grade II-IV, 57% versus 56%; grade III-IV, 13% versus 17%), but the 5-year incidence of chronic GVHD was higher among RTX-treated patients (62% versus 47%). In patients with relapsed or refractory non-Hodgkin lymphoma, peritransplantation RTX neither reduced relapse nor improved GVHD. The role of donor-recipient pairing by FCγRIIIa polymorphisms in outcomes remains to be determined.
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9
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Predictive value of disease risk comorbidity index for overall survival after allogeneic hematopoietic transplantation. Blood Adv 2020; 3:230-236. [PMID: 30674457 DOI: 10.1182/bloodadvances.2018018549] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 12/13/2018] [Indexed: 12/25/2022] Open
Abstract
Allogeneic hematologic cell transplantation (alloHCT) is the only curative therapy for many adults with hematological malignancies. However, it can be associated with substantial risks of morbidity and mortality that are dependent on patient comorbidity- or disease risk-related factors. Several pretransplantation prognostic scoring systems have been developed to estimate survival of patients undergoing alloHCT; however, there is significant interstudy variability in the predictive capacity of these assessment tools. We tested the prognostic capability of a composite scoring system including the disease risk index and HCT comorbidity index (DRCI). The DRCI scoring system was applied pretransplantation to determine whether it predicted clinical outcomes of 959 adult patients with hematological malignancies undergoing alloHCT from 2000 to 2013 at the University of Minnesota. The DRCI score categorized patients into 6 risk groups, with 2-year overall survival ranging between 74% for the very low-risk DRCI group and 34% for the very high-risk DRCI group. In multiple regression analyses adjusted for patient age and donor type, the risk of overall mortality independently increased as the DRCI score increased. Additionally, the DRCI score independently predicted risk of relapse, disease-free survival, and graft-versus-host disease-free/relapse-free survival. Our data demonstrate that the pretransplantation DRCI scoring system predicts outcomes after alloHCT and can be used to guide clinical decision making for patients considering alloHCT.
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10
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Jacobson CA, Farooq U, Ghobadi A. Axicabtagene Ciloleucel, an Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy for Relapsed or Refractory Large B-Cell Lymphoma: Practical Implications for the Community Oncologist. Oncologist 2020; 25:e138-e146. [PMID: 31585984 PMCID: PMC6964143 DOI: 10.1634/theoncologist.2019-0395] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/18/2019] [Indexed: 01/23/2023] Open
Abstract
Axicabtagene ciloleucel is the first U.S. Food and Drug Administration-approved autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy for the treatment of patients with relapsed or refractory large B-cell lymphoma after ≥2 prior systemic therapies. Although axicabtagene ciloleucel is administered only at authorized treatment centers, community oncologists play a critical role in the CAR T-cell treatment journey, recognizing potentially eligible patients for referral and then, after treatment, closely collaborating with treatment centers to monitor and manage patients long term. ZUMA-1, the pivotal, multicenter, phase I/II study of 108 patients treated with axicabtagene ciloleucel, resulted in an objective response rate of 83%, including 58% complete responses. With a 27.1-month median follow-up, 39% of patients had ongoing responses. CAR T-cell therapy is associated with the potentially life-threatening adverse events (AEs) of cytokine release syndrome and neurologic events, which generally occur early after treatment. In ZUMA-1, cytokine release syndrome and neurologic events were generally reversible and grade ≥3 cytokine release syndrome and neurologic events occurred in 11% and 32% of patients, respectively. Frequent prolonged AEs included hypogammaglobulinemia, B-cell aplasia, and cytopenias requiring supportive care until recovery of hematopoietic function. Rate of treatment-related mortality was low, at <2%. With appropriate management of common AEs, axicabtagene ciloleucel offers the potential for long-term durable responses in patients who otherwise lack curative treatment options. IMPLICATIONS FOR PRACTICE: Community oncologists should be familiar with key aspects of chimeric antigen receptor (CAR) T-cell indications and eligibility to help recognize and refer potential patients for this paradigm-changing treatment option at the appropriate time during the disease course. To ensure optimal long-term outcomes for patients who have been treated with CAR T-cell therapy, oncologists must also be familiar with common prolonged AEs and their monitoring and management.
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MESH Headings
- Antigens, CD19/physiology
- Antigens, CD19/therapeutic use
- Biological Products
- Humans
- Immunotherapy, Adoptive
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Receptors, Antigen, T-Cell/immunology
- Receptors, Chimeric Antigen/immunology
- Survival Analysis
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Affiliation(s)
| | | | - Armin Ghobadi
- Washington University School of Medicine and Siteman Cancer CenterSt. LouisMissouriUSA
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11
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Izumi K, Kanda J, Nishikori M, Arai Y, Ishikawa T, Yoshioka S, Ueda Y, Maeda T, Yonezawa A, Anzai N, Moriguchi T, Imada K, Akasaka T, Nohgawa M, Itoh M, Aiba A, Tsunemine H, Watanabe M, Kondo T, Takaori-Kondo A. Outcomes of allogeneic stem cell transplantation for DLBCL: a multi-center study from the Kyoto Stem Cell Transplantation Group. Ann Hematol 2019; 98:2815-2823. [PMID: 31713653 DOI: 10.1007/s00277-019-03835-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) has been considered as a potentially curative treatment option for refractory or relapsed diffuse large B cell lymphoma (DLBCL) patients. However, there is little information available, especially for Japanese patients and in cord blood transplantation (CBT). We aimed to determine treatment outcomes of allo-SCT for DLBCL in the Kyoto Stem Cell Transplantation Group, a multi-institutional joint research group. Sixty-eight DLBCL patients who underwent their first allo-SCT between 2003 and 2016 were included. The median time from diagnosis to transplantation was 13.5 months. Thirty-one patients were in CR/PR at transplantation. Twenty-seven patients underwent CBT. The median follow-up for survivors was 44.2 months. Four-year overall survival (OS) and relapse-free survival (RFS) rates were 23% (95% CI, 13-35%) and 20% (95% CI, 11-31%), respectively. Cumulative incidences of non-relapse mortality and relapse were 23% and 57%, respectively. Patients in CR/PR at allo-SCT had better OS (4-year, 46% vs 4%, P < 0.001) and RFS (4-year, 36% vs 7%, P = 0.005). The source of the stem cell did not significantly affect OS (4-year, bone marrow vs cord blood vs peripheral blood, 28.6% vs 27.2% vs 6.5%, P = 0.193). In multivariate analysis, non-remission status at SCT associated with inferior OS and RFS. Duration from diagnosis to transplantation of less than 1 year associated with inferior RFS. Allo-SCT, including CBT, may be a promising therapeutic modality for DLBCL patients who have good disease control at transplantation.
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Affiliation(s)
- Kiyotaka Izumi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Momoko Nishikori
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Maeda
- Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akihito Yonezawa
- Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Naoyuki Anzai
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | | | - Kazunori Imada
- Department of Hematology, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Masaharu Nohgawa
- Department of Hematology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsuru Itoh
- Department of Hematology, Kyoto City Hospital, Kyoto, Japan
| | - Akiko Aiba
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | | | - Mitsumasa Watanabe
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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R-BEAM versus Reduced-Intensity Conditioning Regimens in Patients Undergoing Allogeneic Stem Cell Transplantation for Relapsed Refractory Diffuse Large B Cell Lymphoma. Biol Blood Marrow Transplant 2019; 26:683-690. [PMID: 31682979 DOI: 10.1016/j.bbmt.2019.10.029] [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: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023]
Abstract
Allogeneic stem cell transplant (alloSCT) is considered in diffuse large B cell lymphoma (DLBCL) patients with chemorefractory disease or who have relapsed after autologous SCT. Here we present the first report of alloSCT using the R-BEAM (rituximab, carmustine, etoposide, cytarabine, melphalan) conditioning regimen in DLBCL patients. We retrospectively compared long-term alloSCT outcomes of DLBCL patients who received either R-BEAM (n = 47) or reduced-intensity conditioning (RIC) regimens (n = 23). Seventy patients (median age, 53 years) with DLBCL received alloSCT between January 2005 and December 2017. The median number of pretransplant therapies was 3, and 17 patients (24%) received prior autologous SCT. All received rituximab as a frontline or salvage therapy before alloSCT. The donor was unrelated in 42 patients (60%), and peripheral blood stem cells were commonly used (96%). The 6-month cumulative incidence of grades III to IV acute graft-versus-host disease (GVHD) was 36.2% and 8.7% for R-BEAM and RIC, respectively (P = .03). Median follow-up of surviving patients after R-BEAM and RIC was 3.1 and 5.5 years, respectively. Three-year overall survival (OS) after R-BEAM and RIC was 34.4% and 43.4%, respectively (P = .48). At 3 years, R-BEAM was associated with a similar relapse rate (25.5% versus 26.1%, P = .96), nonrelapse mortality (NRM; 39.7% versus 39.1%, P = .98), and relapse-free survival (RFS; 34.8% versus 34.7%, P = .75) compared with RIC. In multivariable analysis lower Karnofsky performance score was associated with lower OS (hazard ratio, .96; P = .05), whereas chemorefractory disease was associated with a higher relapse risk (hazard ratio, 8.8; P = .04). No difference in OS, relapse, NRM, or RFS was noticed between R-BEAM and RIC. R-BEAM regimen seems to be feasible and results in equivalent rates of long-term OS, relapse, NRM, and RFS compared with RIC. However, a significantly higher rate of severe acute GVHD was noticed.
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Hunter BD, Chen YB, Jacobson CA. Allogeneic Stem Cell Transplantation and Chimeric Antigen Receptor (CAR) T-Cell Therapy for the Treatment of Non-Hodgkin Lymphoma. Hematol Oncol Clin North Am 2019; 33:687-705. [PMID: 31229163 DOI: 10.1016/j.hoc.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite the myriad of available treatments, a substantial subset of patients with non-Hodgkin lymphoma are not able to achieve a prolonged disease-free interval with conventional chemotherapy or targeted agents. For these patients, hematopoietic stem cell transplantation remains an option for consolidative or curative treatment. Additionally, chimeric antigen receptor T-cell therapy has emerged for patients with relapsed/refractory B-cell lymphomas. Published studies vary widely in their selected approach to transplant and cellular therapies. This review summarizes available data related to allogeneic hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy for the treatment of non-Hodgkin lymphomas.
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Affiliation(s)
- Bradley D Hunter
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA.
| | - Yi-Bin Chen
- Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA
| | - Caron A Jacobson
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
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14
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Dahi PB, Moskowitz CH, Giralt SA, Lazarus HM. Novel agents may positively impact chemotherapy and transplantation in subsets of diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:407-418. [PMID: 30884247 DOI: 10.1080/17474086.2019.1596793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Molecular and biologic heterogeneity in diffuse large B-cell lymphoma (DLBCL) has resulted in a broad range of clinical outcomes. While standard frontline chemoimmunotherapy cures majority of patients with DLBCL, treatment failure in certain DLBCL subsets remains high. Prognosis in these patients is dismal. Therefore, optimization of front-line therapy, as well as development of more effective salvage treatments, is an unmet medical need. Areas covered: This article reviews the treatment advances in DLBCL with novel and targeted agents that are aimed to improve efficacy especially in those with high-risk features. Expert opinion: Incorporation of novel therapies such as immunomodulatory agents and Bruton tyrosine kinase (BTK) inhibitors in the treatment of higher-risk DLBCL subgroups have shown to be effective; however, confirmatory data are required to change the standard of care. While autologous chimeric antigen receptor (CAR) T-cell therapy targeting CD19-positive B-cells have revolutionized the outcomes of refractory DLBCL, the complexity of its production, post-infusion care, and the associated cost, currently has limited its use to select academic centers in the US. A multitude of other targeted agents and combinations as well as cellular and immunotherapeutic agents are under investigation.
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Affiliation(s)
- Parastoo B Dahi
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Craig H Moskowitz
- c Sylvester Comprehensive Cancer Center , University of Miami , Coral Gables , FL , USA
| | - Sergio A Giralt
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Hillard M Lazarus
- d Case Comprehensive Cancer Center , Case Western Reserve University , Cleveland , OH , USA
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15
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Jurczak W, Długosz-Danecka M, Rivas Navarro F. The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions. Future Oncol 2019; 15:305-317. [DOI: 10.2217/fon-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.
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Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków 31-501, Poland
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16
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Puronen CE, Cassaday RD, Stevenson PA, Sandmaier BM, Flowers ME, Green DJ, Maloney DG, Storb RF, Press OW, Gopal AK. Long-Term Follow-Up of 90Y-Ibritumomab Tiuxetan, Fludarabine, and Total Body Irradiation-Based Nonmyeloablative Allogeneic Transplant Conditioning for Persistent High-Risk B Cell Lymphoma. Biol Blood Marrow Transplant 2018; 24:2211-2215. [PMID: 30454872 PMCID: PMC6251312 DOI: 10.1016/j.bbmt.2018.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) can provide prolonged remissions in patients with advanced B cell lymphoma (B-NHL) via the graft-versus-lymphoma effect, although inferior results are seen in patients with chemoresistant, bulky, or aggressive disease. Radioimmunotherapy can safely induce responses in B-NHL with minimal nonhematologic toxicity. Initial results of 90Y-ibritumomab tiuxetan-based allografting demonstrated early safety and disease control in nonremission patients but with short follow-up. Here we report the long-term outcomes of patients treated on this study with specific emphasis on patients achieving early remissions. Eleven of 40 patients were alive at a median follow-up of 9 years (range, 5.3 to 10.2). Fourteen (35%) deaths were due to disease progression and 14 (35%) deaths to complications from HCT. One patient died of a Merkel cell carcinoma. The 5-year overall and progression-free survival for patients with indolent B-NHL was 40% and 27.5%, respectively. None of the patients with diffuse large B cell lymphoma was a long-term disease-free survivor regardless of early remission status. 90Y-ibritumomab tiuxetan-based allografting represents a viable option in patients with indolent histologies. Improved strategies are needed for aggressive B-NHL. The original trial was registered at www.clinicaltrials.gov as NCT00119392.
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Affiliation(s)
- Camille E Puronen
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ryan D Cassaday
- Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Philip A Stevenson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Brenda M Sandmaier
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E Flowers
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Damian J Green
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David G Maloney
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rainer F Storb
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Oliver W Press
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ajay K Gopal
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Salhotra A, Mei M, Stiller T, Mokhtari S, Herrera AF, Chen R, Popplewell L, Zain J, Ali H, Sandhu K, Budde E, Nademanee A, Forman SJ, Nakamura R. Outcomes of Patients with Recurrent and Refractory Lymphoma Undergoing Allogeneic Hematopoietic Cell Transplantation with BEAM Conditioning and Sirolimus- and Tacrolimus-Based GVHD Prophylaxis. Biol Blood Marrow Transplant 2018; 25:287-292. [PMID: 30227232 DOI: 10.1016/j.bbmt.2018.09.009] [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] [Received: 07/11/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
The current standard of care for patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is high-dose conditioning followed by autologous stem cell transplantation (ASCT). For some patients (ie, those with highest-risk disease, insufficient stem cell numbers after mobilization, or bone marrow involvement) allogeneic hematopoietic cell transplantation (alloHCT) offers the potential for cure. However, the majority of patients undergoing alloHCT receive reduced-intensity conditioning as a preparative regimen, and studies assessing outcomes of patients after alloHCT with myeloablative conditioning are limited. In this retrospective study, we reviewed outcomes of 22 patients with recurrent and refractory NHL who underwent alloHCT with myeloablative BEAM conditioning and received tacrolimus/sirolimus as graft-versus-host disease (GVHD) prophylaxis at City of Hope between 2005 and 2018. With a median follow-up of 2.6 years (range, 1.0 to 11.2 years), the probabilities of 2-year overall survival and event-free survival were 58.3% (95% confidence interval [CI], 35.0% to 75.8%) and 45.5% (95% CI, 24.4% to 64.3%), respectively. The cumulative incidence of grade II to IV acute GVHD was 45.5% (95% CI, 23.8% to 64.9%), with only 1 patient developing grade IV acute GVHD. However, chronic GVHD was seen in 55% of the patients (n = 12). Of the 22 eligible patients, 2 had undergone previous ASCT and 2 had undergone previous alloHCT. Both patients with previous ASCT developed severe regimen-related toxicity. Patients who underwent alloHCT with chemorefractory disease had lower survival rates, with 1-year OS and EFS of 44.4% and 33.0%, respectively. In conclusion, alloHCT with a BEAM preparative regimen and tacrolimus/sirolimus-based GVHD should be considered as an alternative option for patients with highest-risk lymphoma whose outcomes are expectedly poor after ASCT.
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Affiliation(s)
- Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Tracey Stiller
- Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Program Development, City of Hope, Duarte, California
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Auayporn Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California.
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18
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Epperla N, Hamadani M, Ahn KW, He F, Kodali D, Kleman A, Hari PN, Pasquini M, Fenske TS, Craig MD, Kanate AS, Bachanova V. Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:983-988. [DOI: 10.1016/j.bbmt.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/13/2018] [Indexed: 01/23/2023]
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19
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Gauthier J, Chantepie S, Bouabdallah K, Jost E, Nguyen S, Gac AC, Damaj G, Duléry R, Michallet M, Delage J, Lewalle P, Morschhauser F, Salles G, Yakoub-Agha I, Cornillon J. [Allogeneic haematopoietic cell transplantation for diffuse large B cell lymphoma: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S131-S135. [PMID: 29173980 DOI: 10.1016/j.bulcan.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022]
Abstract
Despite great improvements in the outcome of patients with lymphoma, some may still relapse or present with primary refractory disease. In these situations, allogeneic hematopoietic cell transplantation is a potentially curative option, this is true particularly in the case of after autologous stem cell transplantation if remission can be achieved. Recently, novel agents such as anti-PD1 and BTK inhibitors have started to challenge the use of allogeneic hematopoietic cell transplantation for relapsed or refractory lymphoma. During the 2016 annual workshop of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), we performed a comprehensive review of the literature published in the last 10 years and established guidelines to clarify the indications and transplant modalities in this setting. This section specifically reports on our conclusions regarding diffuse large B cell lymphoma.
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Affiliation(s)
- Jordan Gauthier
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Sylvain Chantepie
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Krimo Bouabdallah
- CHU Caen, service d'hématologie, Caen, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Edgar Jost
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Stéphanie Nguyen
- CHU Haut-Lévêque, service d'hématologie, Bordeaux, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Anne-Claire Gac
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gandhi Damaj
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Rémy Duléry
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Mauricette Michallet
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Jérémy Delage
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Montpellier, service d'hématologie, Montpellier, France
| | - Philippe Lewalle
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut Jules-Bordet, université Libre-de-Bruxelles, service d'hématologie, Bruxelles, Belgique
| | - Franck Morschhauser
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gilles Salles
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Ibrahim Yakoub-Agha
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Lille, LIRIC Inserm U995, université de Lille-2, 59000 Lille, France
| | - Jérôme Cornillon
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut de cancérologie Lucien-Neuwirth, département d'hématologie clinique, Saint-Priest-en-Jarez, France.
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20
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Abstract
New therapies are needed for patients with Hodgkin or non-Hodgkin lymphomas that are resistant to standard therapies. Indeed, unresponsiveness to standard chemotherapy and relapse after autologous stem-cell transplantation are indicators of an especially poor prognosis. Chimeric antigen receptor (CAR) T cells are emerging as a novel treatment modality for these patients. Clinical trial data have demonstrated the potent activity of anti-CD19 CAR T cells against multiple subtypes of B-cell lymphoma, including diffuse large-B-cell lymphoma (DLBCL), follicular lymphoma, mantle-cell lymphoma, and marginal-zone lymphoma. Importantly, anti-CD19 CAR T cells have impressive activity against chemotherapy-refractory lymphoma, inducing durable complete remissions lasting >2 years in some patients with refractory DLBCL. CAR-T-cell therapies are, however, associated with potentially fatal toxicities, including cytokine-release syndrome and neurological toxicities. CAR T cells with novel target antigens, including CD20, CD22, and κ-light chain for B-cell lymphomas, and CD30 for Hodgkin and T-cell lymphomas, are currently being investigated in clinical trials. Centrally manufactured CAR T cells are also being tested in industry-sponsored multicentre clinical trials, and will probably soon become a standard therapy. Herein, we review the clinical efficacy and toxicity of CAR-T-cell therapies for lymphoma, and discuss their limitations and future directions with regard to toxicity management, CAR designs and CAR-T-cell phenotypes, conditioning regimens, and combination therapies.
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21
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Epperla N, Hamadani M. Hematopoietic cell transplantation for diffuse large B-cell and follicular lymphoma: Current controversies and advances. Hematol Oncol Stem Cell Ther 2017. [PMID: 28633038 DOI: 10.1016/j.hemonc.2017.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with diverse biologic, histologic, and clinical features. With a better understanding of the molecular pathogenesis, recently there have been major advances in the treatment of NHLs including addition of novel monoclonal antibodies, targeted therapies, and immune activators to the therapy armamentarium. Despite these remarkable developments, autologous hematopoietic cell transplantation (auto-HCT) remains not only a standard-of-care curative option for aggressive NHL but also an important therapeutic option for indolent NHL. In NHL, for patients with high-risk features, including those heavily pretreated or with refractory disease or those experiencing failure after an auto-HCT, allogeneic HCT (allo-HCT) remains the only curative option. In this review, we briefly discuss the role of transplantation in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). In DLBCL patients, we discuss the role of HCT in clinically and biologically defined ultra-high-risk disease. In FL patients, auto-HCT is best reserved for relapsed chemosensitive patients after two to three lines of prior chemoimmunotherapies, who are not candidates for allo-HCT, either because of donor unavailability, associated comorbidities, or patient preference. Reduced-intensity conditioning allo-HCT offers the curative option for patients with relapsed/refractory FL. Although the emergence of targeted, biologic, and immunological therapies is welcoming, it is currently unclear how these new therapies might enhance or replace allo-HCT. Until we have further definitive data, allo-HCT remains the only curative option.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for International Blood and Marrow Transplant Research, Milwaukee, WI 53226, USA.
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22
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Kharfan-Dabaja MA, El-Jurdi N, Ayala E, Kanate AS, Savani BN, Hamadani M. Is myeloablative dose intensity necessary in allogeneic hematopoietic cell transplantation for lymphomas? Bone Marrow Transplant 2017; 52:1487-1494. [PMID: 28368373 DOI: 10.1038/bmt.2017.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/21/2016] [Accepted: 01/08/2017] [Indexed: 12/25/2022]
Abstract
The advent of novel immunotherapy and tyrosine kinase inhibitors has ushered a new era in the treatment of Hodgkin and non-Hodgkin lymphomas. Allogeneic hematopoietic cell transplantation remains, however, a vital component in the management and potential cure of lymphomas, especially in the relapsed setting. Considering the biological and clinical heterogeneity of various subtypes of lymphomas, the optimal intensity of conditioning regimens remains controversial. Reduced intensity conditioning regimens have broadened applicability of the procedure to older and frail patients. Observational studies suggest that although reduced intensity allografting is associated with higher risk of relapse, overall survival is comparable and in some cases even better, than observed with myeloablative regimens. Here, we review the available published data pertaining to allogeneic hematopoietic cell transplantation using reduced intensity or myeloablative conditioning for various lymphoma histologies. Owing to the lack of randomized prospective trials, recommendations are mainly based on registry and single-institution studies. Special emphasis must be given to implementing strategies to prevent relapse when using reduced intensity regimens. Identifying particular patients who may benefit from myeloablative regimens in lymphomas remains to be better defined.
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Affiliation(s)
- M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - N El-Jurdi
- Division of Hematology-Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - E Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - A S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - B N Savani
- Division of Hematology and Oncology and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Hamadani
- Division of Hematology-Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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23
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Late Relapses After High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Diffuse Large B-cell Lymphoma in the Rituximab Era. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:145-151. [DOI: 10.1016/j.clml.2016.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/19/2016] [Accepted: 11/10/2016] [Indexed: 12/24/2022]
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24
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Cabrero M, Martin A, Briones J, Gayoso J, Jarque I, López J, Grande C, Heras I, Arranz R, Bernal T, Perez-Lopez E, López-Godino O, Conde E, Caballero D. Phase II Study of Yttrium-90-Ibritumomab Tiuxetan as Part of Reduced-Intensity Conditioning (with Melphalan, Fludarabine ± Thiotepa) for Allogeneic Transplantation in Relapsed or Refractory Aggressive B Cell Lymphoma: A GELTAMO Trial. Biol Blood Marrow Transplant 2017; 23:53-59. [DOI: 10.1016/j.bbmt.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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25
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Chaganti S, Illidge T, Barrington S, Mckay P, Linton K, Cwynarski K, McMillan A, Davies A, Stern S, Peggs K. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol 2016; 174:43-56. [PMID: 27196701 DOI: 10.1111/bjh.14136] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Humans
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Disease Management
- Doxorubicin/therapeutic use
- Frailty/therapy
- HIV Infections/complications
- HIV Infections/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/therapy
- Prednisone/therapeutic use
- Rituximab
- Salvage Therapy/methods
- United Kingdom
- Vincristine/therapeutic use
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Affiliation(s)
- Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Illidge
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Sally Barrington
- PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Pam Mckay
- Department of Haematology, West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Linton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | | | - Andy Davies
- Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - Simon Stern
- Department of Haematology, St Helier Hospital, Carshalton, UK
| | - Karl Peggs
- Department of Haematology, University College Hospital, London, UK
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26
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Kennedy VE, Savani BN, Greer JP, Kassim AA, Engelhardt BG, Goodman SA, Sengsayadeth S, Chinratanalab W, Jagasia M. Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and Rituximab Is Associated with Improved Outcomes Compared with Fludarabine and Busulfan after Allogeneic Stem Cell Transplantation for B Cell Malignancies. Biol Blood Marrow Transplant 2016; 22:1801-1807. [PMID: 27377900 DOI: 10.1016/j.bbmt.2016.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
Reduced-intensity conditioning (RIC) has been used increasingly for allogeneic hematopoietic cell transplantation to minimize transplant-related mortality while maintaining the graft-versus-tumor effect. In B cell lymphoid malignancies, reduced-intensity regimens containing rituximab, an antiCD20 antibody, have been associated with favorable survival; however, the long-term outcomes of rituximab-containing versus nonrituximab-containing regimens for allogeneic hematopoietic cell transplantation in B cell lymphoid malignancies remain to be determined. We retrospectively analyzed 94 patients who received an allogeneic transplant for a B cell lymphoid malignancy. Of these, 33 received RIC with fludarabine, cyclophosphamide, and rituximab (FCR) and graft-versus-host disease (GVHD) prophylaxis with a calcineurin inhibitor and mini-methotrexate, and 61 received RIC with fludarabine and busulfan (FluBu) and GVHD prophylaxis with a calcineurin inhibitor and mycophenolate mofetil. The 2-year overall survival was superior in patients who received FCR versus FluBu (72.7% versus 54.1%, P = .031), and in multivariable analysis adjusted for Disease Risk Index and donor type, only the conditioning regimen (FluBu versus FCR: HR, 2.06; 95% CI, 1.04 to 4.08; P = .037) and Disease Risk Index (low versus intermediate/high: HR, .38; 95% CI, .17 to .86; P = .02) were independent predictors of overall survival. The 2-year cumulative incidence of chronic GVHD was lower in patients who received FCR versus FluBu (24.2% versus 51.7%, P = .01). There was no difference in rate of relapse/progression or acute GVHD. Our results demonstrate that the use of RIC with FCR and GVHD prophylaxis with a calcineurin inhibitor and mini-methotrexate is associated with decreased chronic GVHD and improved overall survival.
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Affiliation(s)
- Vanessa E Kennedy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John P Greer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Adetola A Kassim
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Brian G Engelhardt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Stacey A Goodman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Salyka Sengsayadeth
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Wichai Chinratanalab
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Madan Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
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27
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Fenske TS, Ahn KW, Graff TM, DiGilio A, Bashir Q, Kamble RT, Ayala E, Bacher U, Brammer JE, Cairo M, Chen A, Chen YB, Chhabra S, D'Souza A, Farooq U, Freytes C, Ganguly S, Hertzberg M, Inwards D, Jaglowski S, Kharfan-Dabaja MA, Lazarus HM, Nathan S, Pawarode A, Perales MA, Reddy N, Seo S, Sureda A, Smith SM, Hamadani M. Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation. Br J Haematol 2016; 174:235-48. [PMID: 26989808 DOI: 10.1111/bjh.14046] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/12/2016] [Indexed: 01/20/2023]
Abstract
For diffuse large B-cell lymphoma (DLBCL) patients progressing after autologous haematopoietic cell transplantation (autoHCT), allogeneic HCT (alloHCT) is often considered, although limited information is available to guide patient selection. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 503 patients who underwent alloHCT after disease progression/relapse following a prior autoHCT. The 3-year probabilities of non-relapse mortality, progression/relapse, progression-free survival (PFS) and overall survival (OS) were 30, 38, 31 and 37% respectively. Factors associated with inferior PFS on multivariate analysis included Karnofsky performance status (KPS) <80, chemoresistance, autoHCT to alloHCT interval <1-year and myeloablative conditioning. Factors associated with worse OS on multivariate analysis included KPS<80, chemoresistance and myeloablative conditioning. Three adverse prognostic factors were used to construct a prognostic model for PFS, including KPS<80 (4 points), autoHCT to alloHCT interval <1-year (2 points) and chemoresistant disease at alloHCT (5 points). This CIBMTR prognostic model classified patients into four groups: low-risk (0 points), intermediate-risk (2-5 points), high-risk (6-9 points) or very high-risk (11 points), predicting 3-year PFS of 40, 32, 11 and 6%, respectively, with 3-year OS probabilities of 43, 39, 19 and 11% respectively. In conclusion, the CIBMTR prognostic model identifies a subgroup of DLBCL patients experiencing long-term survival with alloHCT after a failed prior autoHCT.
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Affiliation(s)
| | - Kwang W Ahn
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tara M Graff
- Medical Oncology Hematology Associates, Des Moines, IA, USA
| | - Alyssa DiGilio
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Qaiser Bashir
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ernesto Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ulrike Bacher
- Department of Haematology/Oncology, University Medicine Goettingen, Goettingen, Germany.,Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany
| | - Jonathan E Brammer
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mitchell Cairo
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, USA
| | - Andy Chen
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR, USA
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Anita D'Souza
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Umar Farooq
- Department of Oncology and Blood Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cesar Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Samantha Jaglowski
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sunita Nathan
- Department of Hematology, Rush University Medical Center, Chicago, IL, USA
| | - Attaphol Pawarode
- Department of Internal Medicine, Blood and Marrow Transplantation Program, Division of Hematology/Oncology, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishitha Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sachiko Seo
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anna Sureda
- Servei d'Hematologia, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain.,European Group for Blood and Marrow Transplantation, Barcelona, Spain
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - Mehdi Hamadani
- Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA.,Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
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28
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Autologous stem cell transplantation for relapsed/refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party. Bone Marrow Transplant 2015; 51:365-71. [PMID: 26618550 DOI: 10.1038/bmt.2015.286] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 09/19/2015] [Indexed: 12/22/2022]
Abstract
In the era of chemoimmunotherapy, the optimal treatment paradigm for relapsed and refractory diffuse large B-cell lymphoma has been challenged. We reviewed the outcome of standard salvage therapy with an autologous stem cell transplant (autoSCT) over the last two decades and the outcome of allogeneic SCT (alloSCT) in the most recent decade. AutoSCT recipients diagnosed between 1992 and 2002 (n=2737) were compared with those diagnosed between 2002 and 2010 (n=3980). Patients diagnosed after 2002 had a significantly lower non-relapse mortality (NRM) and relapse incidence (RI) and a superior PFS and overall survival (OS). A total of 4210 patients diagnosed between 2002 and 2010 underwent either an autoSCT or an alloSCT as their first transplant procedure. Two-hundred and thirty patients received an alloSCT (myeloablative (MACalloSCT) n=132, reduced intensity (RICalloSCT) n=98). The 4-year NRM rates were 7%, 20% and 27% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year RI was 45%, 40% and 38% for autoSCT, RICalloSCT and MACalloSCT, respectively (NS). The 4-year PFS were 48%, 52% and 35% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year OS was 60%, 52% and 38% for autoSCT, RIC alloSCT and MACalloSCT, respectively. After adjustment for confounding factors NRM was significantly worse for patients undergoing alloSCT whilst there was no difference in the RI.
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29
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Pingali SR, Champlin RE. Pushing the envelope-nonmyeloablative and reduced intensity preparative regimens for allogeneic hematopoietic transplantation. Bone Marrow Transplant 2015; 50:1157-67. [PMID: 25985053 PMCID: PMC4809137 DOI: 10.1038/bmt.2015.61] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) was originally developed to allow delivery of myeloablative doses of chemotherapy and radiotherapy. With better understanding of disease pathophysiology, the graft vs malignancy (GVM) effect of allogeneic hematopoietic transplantation and toxicities associated with myeloablative conditioning (MAC) regimens, the focus shifted to developing less toxic conditioning regimens to reduce treatment-related morbidity without compromising survival. Although HCT with MAC is preferred to reduced intensity conditioning (RIC) for most patients ⩽60 years with AML/myelodysplastic syndrome and ALL, RIC and nonmyeloablative (NMA) regimens allow HCT for many otherwise ineligible patients. Reduced intensity preparative regimens have produced high rates of PFS for diagnoses, which are highly sensitive to GVM. Relapse of the malignancy is the major cause of treatment failure with RIC/NMA HCT. Incorporation of novel agents like bortezomib or lenalidomide, addition of cellular immunotherapy and use of targeted radiation therapies could further improve outcome. In this review, we discuss commonly used RIC/NMA regimens and promising novel regimens.
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Affiliation(s)
- S R Pingali
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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30
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Clinical outcomes of a novel combination of lenalidomide and rituximab followed by stem cell transplantation for relapsed/refractory aggressive B-cell non-hodgkin lymphoma. Oncotarget 2015; 5:7368-80. [PMID: 25228589 PMCID: PMC4202129 DOI: 10.18632/oncotarget.2255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We retrospectively compared outcomes of patients with relapsed/refractory non-Hodgkin lymphoma (NHL) who underwent stem cell transplantation (SCT) with stable disease or better following a novel combination of lenalidomide and rituximab (LR) treatment and did not undergo SCT in a phase I/II clinical trial. We retrospectively compared outcomes of patients who underwent SCT with that of patients who had stable disease or better following LR treatment and did not undergo SCT. Twenty-two patients enrolled in LR clinical trial and undergone SCT were identified, 13 with mantle cell lymphoma (MCL) and nine with large B-cell lymphoma (LBCL). All patients who underwent SCT achieved complete response. In the MCL subset, there were no significant differences between SCT and non-SCT groups except that non-SCT patients were older and had a higher mantle-cell international prognostic index score. There was no difference between SCT-group and non-SCT-group in response duration (P=0.3), progression-free survival (PFS) (P=0.304) and overall survival (OS) (P=0.87). In LBCL subgroup, there were no significant differences between two groups except that non-SCT group had a higher international prognostic index score. Patients with LBCL who underwent SCT had significantly longer response duration (P=0.001), PFS (P=0.000), and OS (P=0.003) than the non-SCT group. The novel therapeutic combination offers a bridge to SCT in patients with relapsed/refractory aggressive B-cell NHL.
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31
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Allogeneic hematopoietic cell transplantation after failed autologous transplant for lymphoma using TLI and anti-thymocyte globulin conditioning. Bone Marrow Transplant 2015; 50:1286-92. [PMID: 26146806 PMCID: PMC4699844 DOI: 10.1038/bmt.2015.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/27/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022]
Abstract
We describe 47 patients with lymphoma and failed prior autologous hematopoietic cell transplantation (HCT) who received TLI-ATG conditioning followed by allogeneic HCT. Thirty-two patients had non-Hodgkin lymphoma (NHL; diffuse large B cell lymphoma [n=19], T-cell NHL [n=6], mantle cell lymphoma [n= 4], or other B-cell subtypes [n=3]), and 15 had Hodgkin lymphoma. The median follow-up was 4.9 (range, 2.1–11.9) years. The cumulative incidence of grade II–IV acute GVHD at day +100 was 12%, and the cumulative incidence of extensive chronic GVHD at 1 year was 36%. The 3-year cumulative incidences of overall survival, progression-free survival (PFS), and non-relapse mortality (NRM) were 81%, 44%, and 7%, respectively. Fifteen patients died (relapse, n=10; NRM, n=5). Among the 25 patients with relapse after allogeneic HCT, 11 (44%) achieved durable (>1 year) complete remissions following donor lymphocyte infusion or chemoradiotherapy. The majority of surviving patients (75%; n=24) were able to discontinue all immunosuppression. For patients with relapsed lymphoma after autologous HCT, allogeneic HCT using TLI-ATG conditioning is a well-tolerated, predominantly outpatient therapy with low NRM (7% at 3 years), a low incidence of GVHD, durable disease control, and excellent overall survival (81% at 3 years).
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32
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Truelove E, Fox C, Robinson S, Pearce R, Perry J, Kirkland K, McQuaker G, Pagliuca A, Johnson P, Russell N, Cook G. Carmustine, Etoposide, Cytarabine, and Melphalan (BEAM)–Campath Allogeneic Stem Cell Transplantation for Aggressive Non-Hodgkin Lymphoma: An Analysis of Outcomes from the British Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:483-8. [DOI: 10.1016/j.bbmt.2014.11.673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/17/2014] [Indexed: 11/26/2022]
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33
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Zoellner AK, Fritsch S, Prevalsek D, Engel N, Hubmann M, Reibke R, Rieger CT, Hellmuth JC, Haas M, Mumm F, Herold T, Ledderose G, Hiddemann W, Dreyling M, Hausmann A, Tischer J. Sequential therapy combining clofarabine and T-cell-replete HLA-haploidentical haematopoietic SCT is feasible and shows efficacy in the treatment of refractory or relapsed aggressive lymphoma. Bone Marrow Transplant 2015; 50:679-84. [PMID: 25642765 DOI: 10.1038/bmt.2014.328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 01/25/2023]
Abstract
Prognosis is poor for patients with biologically aggressive Non-Hodgkin lymphoma (NHL), refractory to chemotherapy or relapsed after autologous transplantation, especially when no disease control before allogeneic transplantation is achieved. In 16 patients (median age 53, median prior regimes 5) with relapsed or refractory non-remission NHL, we analysed retrospectively the efficacy of a sequential therapy comprising clofarabine re-induction followed by a reduced-intensity conditioning with fludarabine, CY and melphalan, and T-cell-replete HLA-haploidentical transplantation. High-dose CY was utilized post-transplantation. All patients engrafted. Early response (day +30) was achieved in 94%. Treatment-related grade III-IV toxicity occurred in 56%, most commonly transient elevation of transaminases (36%), while there was a low incidence of infections (19% CMV reactivation, 19% invasive fungal infection) and GVHD (GVHD: acute III-IV: 6%; mild chronic: 25%). One-year non-relapse mortality was 19%. After a median follow-up of 21 months, estimated 1- and 2-year PFS was 56 and 50%, respectively, with 11 patients (69%) still alive after 2 years. In summary, sequential therapy is feasible and effective and provides an acceptable toxicity profile in high-risk non-remission NHL. Presumably, cytotoxic reinduction with clofarabine provides enough remission time for the graft-versus lymphoma effect of HLA-haploidentical transplantation to kick in, even in lymphomas that are otherwise chemo-refractory.
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Affiliation(s)
- A-K Zoellner
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - S Fritsch
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - D Prevalsek
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - N Engel
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Hubmann
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - R Reibke
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - C T Rieger
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - J C Hellmuth
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Haas
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - F Mumm
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - T Herold
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - G Ledderose
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - W Hiddemann
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - M Dreyling
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
| | - A Hausmann
- 1] Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany [2] Department I of Internal Medicine, Klinikum München-Schwabing, Munich, Germany
| | - J Tischer
- Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Department III of Internal Medicine, Hematopoietic Stem Cell Transplantation, Munich, Germany
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Ayala E, Figueroa J, Perkins J, Kim J, Yue B, Riches M, Nishihori T, Locke F, Anasetti C, Kharfan-Dabaja MA. Myeloablative intravenous pharmacokinetically targeted busulfan plus fludarabine as conditioning for allogeneic hematopoietic cell transplantation in patients with non-Hodgkin lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:335-40. [PMID: 25659459 DOI: 10.1016/j.clml.2014.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Mortality associated with allogeneic hematopoietic cell transplantation (allo-HCT) has limited its broader application in patients with non-Hodgkin lymphoma (NHL). Pharmacokinetic treatment with targeted intravenous busulfan combined with fludarabine (BuFlu) was developed as a preparative regimen for acute leukemia and myelodysplasia. Data from this regimen in lymphoid malignancies are limited. PATIENTS AND METHODS We assessed outcomes in 60 consecutive patients with various subtypes of NHL and a median age of 54 years (range, 27-68 years) who received allo-HCT with targeted intravenous BuFlu between December 2004 and August 2010. The median number of previous therapies was 3 (range, 1-8) and median time from diagnosis to HCT was 32 months (range, 4.5-177.5 months). RESULTS At conditioning, 28 (47%) patients had a complete response (CR). Graft versus host disease (GVHD) prophylaxis consisted of tacrolimus plus methotrexate in 65% of cases. Donors were matched/related (n = 32 [53%]), matched/unrelated (n = 21 [35%]), or mismatched/unrelated (n = 7 [12%]). All patients underwent grafting. The cumulative incidence of grade II/IV acute GVHD was 74% (grade III/IV was 20%). The 2-year cumulative incidence of moderate to severe chronic GVHD was 62%. Nonrelapse mortality (NRM) at 100 days and 3 years was 10% and 25%, respectively. The cumulative incidence of relapse was 27%. Three-year progression-free and overall survival for all patients was 47.8% and 55%, respectively. CONCLUSION Targeted intravenous BuFlu is a relatively well tolerated regimen and offers an alternative option when myeloablation is deemed necessary in patients with NHL.
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Affiliation(s)
- Ernesto Ayala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL.
| | - Javier Figueroa
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Janelle Perkins
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Jongphil Kim
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Binglin Yue
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Marcie Riches
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
| | - Frederick Locke
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL
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Aldoss I, Nademanee A. Allogeneic hematopoietic cell transplantation in non-Hodgkin's lymphomas. Cancer Treat Res 2015; 165:329-344. [PMID: 25655617 DOI: 10.1007/978-3-319-13150-4_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Allogeneic hematopoietic cell transplant (alloHCT) has emerged as a potential curative treatment for advanced non-Hodgkin's lymphoma (NHL), especially for patients with chemorefractory disease, relapsed after prior autologous HCT and those with relapsed lymphoma who failed to collect adequate stem cells for autologous HCT. There are several phase II studies supported the role of alloHCT in low-grade lymphomas, but the data is scarce on the other subtypes of lymphomas. However, retrospective registries studies highlighted the inferior outcomes of alloHCT in aggressive lymphomas, with unacceptable higher relapse rate and non-relapse mortality when compared to low-grade lymphomas. Patients with chemorefractory disease and those with active disease at alloHCT had poor outcome. Therefore, incorporation of new target therapies to induce remission prior to transplant or as a bridge to alloHCT may lead to better outcome of alloHCT in NHL. Furthermore, well design prospective studies of alloHCT in NHL and employment of novel transplant approaches tailored toward specific histological subtype are urgently needed.
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Affiliation(s)
- Ibrahim Aldoss
- City of Hope National Medical Center, Hematology and Hematopoietic Cell Transplantation, 1500 East Duarte Road, Duarte, CA, 91010, USA
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Abstract
Relapsed-Refractory Diffuse Large B Cell Lymphoma (RR DLBCL), which accounts for approximately one-third of patients with DLBCL, remains a major cause of morbidity and mortality. Managing RR DLBCL continues to be a challenge to the treating hemato-oncologist. Salvage high-dose chemotherapy followed by autologous stem cell transplantation is the standard of care for chemosensitive relapses in DLBCL. Various salvage regimens are available, but the quest for an optimal regimen continues. The addition of rituximab to the salvage regimen has improved the outcome of RR DLBCL. Several pertinent issues regarding the management of RR DLBCL are discussed in this short review.
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Affiliation(s)
- Lalit S Raut
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Prantar P Chakrabarti
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, West Bengal, India
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Sauter CS, Chou JF, Papadopoulos EB, Perales MA, Jakubowski AA, Young JW, Scordo M, Giralt S, Castro-Malaspina H. A prospective study of an alemtuzumab containing reduced-intensity allogeneic stem cell transplant program in patients with poor-risk and advanced lymphoid malignancies. Leuk Lymphoma 2014; 55:2739-47. [PMID: 24528216 DOI: 10.3109/10428194.2014.894185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplant (allo-SCT) have used alemtuzumab to abrogate the risk of graft-versus-host disease (GVHD). Thirty-eight patients with advanced lymphoma underwent a prospective phase II study of melphalan, fludarabine and alemtuzumab containing RIC allo-SCT from 20 matched related and 18 unrelated donors with cyclosporine-A as GVHD prophylaxis. The cumulative incidence of grade II-IV acute GVHD at 3 months was 10.5% and three evaluable patients experienced chronic GVHD. Progression-free (PFS) and overall (OS) survival at 5 years was 25% (95% confidence interval [CI]: 13-40%) and 44% (95% CI: 28-59%), respectively. Previous high-dose therapy and autologous stem cell transplant (HDT-ASCT) and elevated lactate dehydrogenase (LDH) at the time of allo-SCT resulted in inferior OS. Within this cohort of patients with high-risk lymphoma, alemtuzumab containing RIC resulted in a low risk of GVHD and a high incidence of progression of disease, especially in those with poor-risk features defined by elevated LDH pre-allo-SCT and previous HDT-ASCT.
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Affiliation(s)
- Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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Kim JW, Kim SW, Tada K, Fukuda T, Lee JH, Lee JJ, Kwon JH, Bang SM, Kim I, Yoon SS, Lee JS, Park S. Allogeneic stem cell transplantation in patients with de novo diffuse large B-cell lymphoma who experienced relapse or progression after autologous stem cell transplantation: a Korea-Japan collaborative study. Ann Hematol 2014; 93:1345-51. [PMID: 24633661 DOI: 10.1007/s00277-014-2045-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
Patients with diffuse large B-cell lymphoma (DLBCL) who failed autologous stem cell transplantation (auto-SCT) generally have a poor prognosis. Allogeneic stem cell transplantation (allo-SCT) has been implemented to overcome this problem. We report clinical outcomes of allo-SCT in patients with de novo DLBCL who failed auto-SCT from four hospitals in Korea and Japan. Thirty patients were included. The median age was 39 (range, 22-59) years. The 5-year event-free survival (EFS) and overall survival (OS) after allo-SCT were 37.9 % and 42.6 %, respectively. There was only a single event beyond 12 months in the Kaplan-Meier curve of EFS. Non-relapse mortality (NRM) was reported in five patients (16.7 %). In the multivariate analysis, the risk factors for EFS were prior chemotherapy lines ≥ 5 (p = 0.010) and chemo-resistant disease (p = 0.007). The risk factors for OS were chemo-resistant disease (p = 0.024) and Eastern Cooperative Oncology Group performance status 2 (p = 0.005). NRM was associated with prior chemotherapy lines ≥ 5 (p = 0.042), chemo-resistant disease (p = 0.009), and poor performance status (p < 0.001). In conclusion, allo-SCT showed considerable efficacy in patients with DLBCL whose disease was relapsed or progressed after auto-SCT. Our data suggest that allo-SCT could be a viable treatment option if patients have fewer lines of prior chemotherapy, chemo-sensitive disease, and/or good PS.
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Affiliation(s)
- Ji-Won Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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Sauter CS, Lechner L, Scordo M, Zheng J, Devlin SM, Fleming SE, Castro-Malaspina H, Moskowitz CH. Pretransplantation fluorine-18-deoxyglucose--positron emission tomography scan lacks prognostic value in chemosensitive B cell non-hodgkin lymphoma patients undergoing nonmyeloablative allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:881-4. [PMID: 24534109 DOI: 10.1016/j.bbmt.2014.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/11/2014] [Indexed: 01/29/2023]
Abstract
Whether chemosensitivity, as determined by positron emission tomography using fluorine-18-deoxyglucose (FDG-PET), is a requirement for successful allogeneic hematopoietic stem cell transplantation (allo-SCT) has yet to be established. We analyzed 88 patients with B cell non-Hodgkin lymphoma (B-NHL) for event-free (EFS) and overall survival (OS) according to computed tomography (CT) and FDG-PET criteria before uniform nonmyeloablative (NMA) allo-SCT. Patients who were chemosensitive, according to CT criteria, experienced significantly greater EFS (P < .001) and OS (P < .03) compared with those who were chemorefractory at the time of allo-SCT. Of 58 patients within this cohort who were chemosensitive by CT criteria, there was no difference in EFS (P = .85) or OS (P = .96) between FDG-PET-positive (Deauville 4 to 5, n = 24) and FDG-PET-negative (Deauville 1 to 3, n = 34) patients. There was no difference in survival according to age < or ≥ 60 years, prior autologous-stem cell transplantation, allograft characteristics, or histology. FDG-PET adds no prognostic value in chemosensitive B-NHL before NMA-allo-SCT.
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Affiliation(s)
- Craig S Sauter
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Lauren Lechner
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen E Fleming
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hugo Castro-Malaspina
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig H Moskowitz
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Matched unrelated donor allogeneic transplantation provides comparable long-term outcome to HLA-identical sibling transplantation in relapsed diffuse large B-cell lymphoma. Bone Marrow Transplant 2014; 49:671-8. [PMID: 24510071 DOI: 10.1038/bmt.2014.4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 01/20/2023]
Abstract
The objective of this retrospective analysis was to compare outcomes of patients with diffuse large B-cell lymphoma (DLBCL) who received either a matched sibling (sib) or an unrelated donor (URD) allogeneic hematopoietic cell transplantation (allo-HCT). Long-term outcome of 172 DLBCL patients receiving URD-HCT between 2000 and 2007 and reported to the European Group for Blood and Marrow Transplantation, was compared with that of 301 subjects, allografted from sib-HCT. With a median follow-up of 45 months, 3-year PFS approached 35% for both groups; overall survival (OS) was 42% for sib-HCT versus 37% for URD (NS). Multivariate analyses confirmed that donor type was not associated with differences in non-relapse mortality (NRM), relapse rate (RR), PFS or OS. Poor performance status (PS) and refractory disease adversely affected PFS and OS. Prior auto-SCT and multiple previous therapies predicted for shorter PFS. NRM was adversely affected by older age (⩾50 years), poor PS and refractory disease, and RR by time from diagnosis to allo-HCT of <36 months, prior auto-SCT, refractory disease, poor PS and in vivo T-cell depletion with alemtuzumab. This large study shows for the first time that URD-HCT is not inferior to sib-HCT, providing a reasonable therapeutic approach for DLBCL patients, having no HLA-identical sibling available.
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Sauter CS, Barker JN, Lechner L, Zheng J, Devlin SM, Papadopoulos EB, Perales MA, Jakubowski AA, Goldberg JD, Koehne G, Ceberio I, Giralt S, Zelenetz AD, Moskowitz CH, Castro-Malaspina H. A phase II study of a nonmyeloablative allogeneic stem cell transplant with peritransplant rituximab in patients with B cell lymphoid malignancies: favorably durable event-free survival in chemosensitive patients. Biol Blood Marrow Transplant 2013; 20:354-60. [PMID: 24315843 DOI: 10.1016/j.bbmt.2013.11.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/29/2013] [Indexed: 01/12/2023]
Abstract
The aim of this prospective phase II trial was to determine the safety and efficacy of a nonmyeloablative conditioning program incorporating peritransplant rituximab in patients with CD20+ B cell non-Hodgkin lymphoma (B-NHL) receiving an allogeneic stem cell transplant (allo-SCT). Fifty-one adult B-NHL patients, with a median age of 54 years, were treated with cyclophosphamide, fludarabine, and 200 cGy of total body irradiation. Rituximab 375 mg/m(2) was given on day -8 and in 4 weekly doses beginning day +21. Equine antithymocyte globulin was given to recipients of volunteer unrelated donor grafts. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil and tacrolimus, sirolimus, and methotrexate in 8 and 43 patients, respectively. Thirty-three patients received grafts from unrelated donors, and 18 received grafts from matched related donors. All patients engrafted. Full donor chimerism in bone marrow and peripheral T cells was seen in 92% and 89% of patients, respectively, at 3 months after allo-SCT. The cumulative incidence of grades II to IV acute GVHD at 6 months was 25% (95% confidence interval [CI], 13% to 38%) and grades III to IV was 11% (95% CI, 2% to 20%). The 2-year cumulative incidence of chronic GVHD was 29% (95% CI, 15% to 44%). The 2-year event-free and overall survival for all patients was 72% (95% CI, 59% to 85%) and 78% (95% CI, 66% to 90%), respectively. The 2-year event-free survival for chemosensitive patients was 84% (95% CI, 72% to 96%) compared with 30% (95% CI, 2% to 58%) for chemorefractory patients before allo-SCT (P < .001). This nonmyeloablative regimen, with peritransplant rituximab, is safe and effective in patients with B-NHL.
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Affiliation(s)
- Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Juliet N Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Lauren Lechner
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Junting Zheng
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jenna D Goldberg
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Guenther Koehne
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Izaskun Ceberio
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Hematology Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Andrew D Zelenetz
- Department of Medicine, Weill Cornell Medical College, New York, New York; Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York; Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Uhm J, Kuruvilla J. Allogeneic stem cell transplantation for diffuse large B cell lymphoma: Defining the role of allografts. Transfus Apher Sci 2013; 49:63-71. [DOI: 10.1016/j.transci.2013.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how? Bone Marrow Transplant 2013; 49:1-7. [PMID: 23708703 DOI: 10.1038/bmt.2013.72] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 12/24/2022]
Abstract
Despite overall improvements in outcomes of patients with diffuse large B cell lymphoma (DLBCL), ∼30-40% of patients develop relapsed or refractory disease. For patients with chemo refractory disease, or recurrent disease following autologous hematopoietic SCT (auto-HCT), the prognosis is poor, with no consensus on the optimal therapy. Currently, owing to the graft vs lymphoma effect, hematopoietic allogeneic hematopoietic cell transplantation (allo-HCT) is the only potentially curative option for such patients. In addition, many patients who are considered today for auto-HCT actually have a low likelihood of benefit. For example, a patient with prior rituximab exposure who relapses within 1 year of diagnosis and has a second-line age-adjusted International Prognosis Index of 2 or 3 at relapse has a <25% chance of being cured by auto-HCT. It is possible that such patients may be better served with an allo-HCT. Unfortunately, in many cases, allo-HCT applicability is limited by patient age, comorbidities, performance status and treatment-related toxicities. Recent attempts to improve the efficacy of auto-HCT, such as incorporating radio-immunotherapy into the conditioning regimen, have not resulted in improved outcomes. However, incorporation of novel agents such as anti-programmed death-1 antibodies as maintenance therapy after auto-HCT show promise. Allo-HCT in relapsed/refractory DLBCL patients can result in a 30-40% PFS rate at 3 years, in part due to a graft vs DLBCL effect. While reduced-intensity/non-myeloablative conditioning is increasingly being used, certain patients may benefit from myeloablative conditioning. We present an algorithm intended to discriminate which relapsed and refractory DLBCL patients are most likely to benefit from auto-HCT vs allo-HCT. New approaches, using novel agents that target the molecular heterogeneity in DLBCL, will be an essential component of moving the field forward. Lastly, we propose a prospective registry-based study as the only feasible mechanism to define the optimal position of allo-HCT in the overall treatment strategy for DLBCL. It is hoped that this review will promote the development of prospective multicenter efforts to determine whether such patients do, in fact, benefit from earlier and/or more effective implementation of allo-HCT.
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Hamadani M, Saber W, Ahn KW, Carreras J, Cairo MS, Fenske TS, Gale RP, Gibson J, Hale GA, Hari PN, Hsu JW, Inwards DJ, Kamble RT, Klein A, Maharaj D, Marks DI, Rizzieri DA, Savani BN, Schouten HC, Waller EK, Wirk B, Laport GG, Montoto S, Maloney DG, Lazarus HM. Impact of pretransplantation conditioning regimens on outcomes of allogeneic transplantation for chemotherapy-unresponsive diffuse large B cell lymphoma and grade III follicular lymphoma. Biol Blood Marrow Transplant 2013; 19:746-53. [PMID: 23380340 PMCID: PMC3650915 DOI: 10.1016/j.bbmt.2013.01.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/26/2013] [Indexed: 10/27/2022]
Abstract
Patients with chemorefractory non-Hodgkin lymphomas generally have a poor prognosis. We used the observational database of the Center for International Blood and Marrow Transplant Research to study the outcome of 533 patients with refractory diffuse large B cell lymphoma (DLBCL) or grade III follicular lymphoma (FL-III) who underwent allogeneic hematopoietic cell transplantation (allo-HCT) using either myeloablative (MA; n = 307) or reduced-intensity/nonmyeloablative conditioning (RIC/NST; n = 226) between 1998 and 2010. We analyzed nonrelapse mortality (NRM), relapse/progression, progression-free survival (PFS), and overall survival (OS). Only 45% of the patients at transplantation had a Karnofsky performance score of ≥90%. Median follow-up of surviving patients after MA and RIC/NST allo-HCT is 35 months and 30 months, respectively. At 3 years, MA allo-HCT was associated with a higher NRM compared with RIC/NST (53% versus 42%; P = .03), similar PFS (19% versus 23%; P = .40), and lower OS (19% versus 28%; P = .02), respectively. On multivariate analysis, FL-III histology was associated with lower NRM (relative risk [RR], .52), reduced risk of relapse/progression (RR, .42), and superior PFS (RR, .51) and OS (RR, .53), whereas MA conditioning was associated with reduced risk of relapse/progression (RR, .66). Despite a refractory state, a small subset of DLBCL and FL-III patients can attain durable remissions after allo-HCT. Conditioning regimen intensity was not associated with PFS and OS despite a higher risk of relapse/progression with RIC/NST allo-HCT.
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MESH Headings
- Adult
- Aged
- Disease Progression
- Disease-Free Survival
- Female
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/surgery
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Grading
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - John Gibson
- Royal Prince Alfred Hospital Institute of Haematology, Camperdown, AUSTRALIA
| | | | - Parameswaran N. Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Jack W. Hsu
- Shands Healthcare and University of Florida, Gainesville, FL
| | | | - Rammurti T. Kamble
- Baylor College of Medicine Center for Cell and Gene Therapy, Houston, TX
| | | | | | | | - David A. Rizzieri
- Duke University Medical Center, Pediatric Blood and Marrow Transplant, Durham, NC
| | | | | | | | - Baldeep Wirk
- Shands Healthcare and University of Florida, Gainesville, FL
| | | | - Silvia Montoto
- Royal London Hospital Whitechapel, St. Bartholomew’s, London, UNITED KINGDOM
| | - David G. Maloney
- Fred Hutchinson Cancer Research Center, Seattle, WA; University Hospitals Case Medical Center, Cleveland, OH
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The role of allogeneic haematopoietic progenitor cell transplantation in patients with diffuse large B-cell non-Hodgkin lymphomas (DLBCL). Bone Marrow Transplant 2013; 48:1271-8. [PMID: 23318539 DOI: 10.1038/bmt.2012.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/04/2012] [Accepted: 11/13/2012] [Indexed: 11/08/2022]
Abstract
Despite the undoubted improvement in the prognosis of patients with diffuse large B-cell lymphomas (DLBCLs) with the addition of rituximab in the front-line treatment, a significant proportion of patients still relapse. Salvage immune-chemotherapy followed by high-dose therapy with autologous haematopoietic cell transplantation (auto-HCT) remains the treatment of choice for such patients, especially in those who demonstrate chemosensitive disease. In recent years, allogeneic haematopoietic cell transplantation (allo-HCT) has increasingly been used for patients who are resistant to salvage treatment or relapse after an auto-HCT. Strategies using reduced intensity conditioning regimens have allowed application of this approach to a broader range of patients. PFS is up to 55% with a risk of relapse up to 80% depending on different studies. In multivariate analysis, several factors have been associated with favourable outcome including chemosensitivity of the disease, younger age and Karnofsky performance status at the time of the transplant being the strongest ones. DLIs have shown to induce durable responses in relapsed or progressed disease; however, its role remains controversial as the results are inferior to the responses seen in other haematological malignancies. More recently, the addition of MoAbs in the non-myeloablative conditioning regimens has shown encouraging results. In conclusion, allo-HCT is a feasible option in selective patients with chemosensitive DBCL, as it reduces the risk of relapse; however, this is achieved at the cost of significant non-relapse mortality.
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Disease status is a more reliable predictive factor than histology in lymphoma patients after reduced-intensity conditioning regimen and allo-SCT. Bone Marrow Transplant 2012; 48:794-8. [DOI: 10.1038/bmt.2012.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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Gill S, Porter DL. Reduced-intensity hematopoietic stem cell transplants for malignancies: harnessing the graft-versus-tumor effect. Annu Rev Med 2012; 64:101-17. [PMID: 23121181 DOI: 10.1146/annurev-med-121411-103452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic cell transplantation combines the power of cytotoxic chemo/radiotherapy with the ability of the new immune system to seek out and destroy tumor cells. However, administration of such myeloablative transplants is fraught with risks, some of which are related to the intensive conditioning regimens. Reductions in the intensity of the administered cytotoxic therapy have demonstrated that under some circumstances, the burden of fighting tumor and enhancing stem cell engraftment can be shouldered mostly by the transplanted immune system. Reduced intensity has allowed a potentially curative therapy for hematologic malignancies to be offered to an expanded patient population. Ongoing research seeks to enhance the safety and power of this form of allogeneic immunotherapy.
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Affiliation(s)
- Saar Gill
- Abramson Cancer Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
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48
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Controversies and recent advances in hematopoietic cell transplantation for follicular non-hodgkin lymphoma. BONE MARROW RESEARCH 2012; 2012:897215. [PMID: 23097707 PMCID: PMC3477524 DOI: 10.1155/2012/897215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/17/2022]
Abstract
Commonly designated as an indolent non-Hodgkin lymphoma, follicular lymphoma (FL) presents with striking pathobiological and clinical heterogeneity. Initial management strategies for FL have evolved to involve combination chemoimmunotherapy and/or radio-immunoconjugates. Unfortunately even with the best available nontransplant treatment, which nowadays results in higher frequency of response, FL remains incurable. Although considered a feasible therapeutic option, the use of hematopoietic cell transplantation (HCT) remains controversial. The appropriate timing, graft source, and intensity of HCT conditioning regimens in FL are often matters of debate. Herein we review the available published data pertaining to the use of autologous or allogeneic HCT in patients with FL across different stages of the disease, discuss major recent advances in the field, and highlight avenues for future research. The current literature does not support a role of HCT for FL in first remission, but in the relapsed setting autologous HCT remains appropriate for patients with early chemosensitive relapses, while allogeneic transplantation remains the sole curative modality for this disease, in relatively younger patients without significant comorbidities.
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Perez-Simón JA, Martino R, Parody R, Cabrero M, Lopez-Corral L, Valcarcel D, Martinez C, Solano C, Vazquez L, Márquez-Malaver FJ, Sierra J, Caballero D. The combination of sirolimus plus tacrolimus improves outcome after reduced-intensity conditioning, unrelated donor hematopoietic stem cell transplantation compared with cyclosporine plus mycofenolate. Haematologica 2012; 98:526-32. [PMID: 23065527 DOI: 10.3324/haematol.2012.065599] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Different types of graft-versus-host disease prophylaxis have been proposed in the setting of reduced intensity and non-myeloablative allogeneic stem cell transplantation. An alternative combination with sirolimus and tacrolimus has recently been tested although comparative studies against the classical combination of a calcineurin inhibitor and mycophenolate mofetil or methotrexate are lacking. We describe the results of a prospective, multicenter trial using sirolimus + tacrolimus as immunoprophylaxis, and compare this approach with our previous experience using cyclosporine + mycophenolate in the setting of unrelated donor transplantation setting after reduced-intensity conditioning. Forty-five patients received cyclosporine + mycophenolate between 2002 and mid-2007, while the subsequent 50 patients, who were transplanted from late 2007, were given sirolimus + tacrolimus. No significant differences were observed in terms of hematopoietic recovery or acute graft-versus-host disease overall, although gastrointestinal acute graft-versus-host disease grade ≥ 2 was more common in the cyclosporine + mycophenolate group (55% versus 21%, respectively, P=0.003). The 1-year cumulative incidence of chronic graft-versus-host disease was 50% versus 90% for the patients treated with the sirolimus- versus cyclosporine-based regimen, respectively (P<0.001), while the incidence of extensive chronic disease was 27% versus 49%, respectively (P=0.043). The 2-year non-relapse mortality rate was 18% versus 38% for patients receiving the sirolimus- versus the cyclosporine-based regimen, respectively (P=0.02). The event-free survival and overall survival at 2 years were 53% versus 29% (P=0.028) and 70% versus 45% (P=0.018) among patients receiving the sirolimus- versus the cyclosporine-based regimen, respectively. In conclusion, in the setting of reduced intensity transplantation from an unrelated donor, promising results can be achieved with the combination of sirolimus + tacrolimus, due to a lower risk of chronic graft-versus-host disease and non-relapse mortality, which translates into better event-free and overall survival rates, in comparison with those achieved with cyclosporine + mycophenolate.
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Affiliation(s)
- Jose Antonio Perez-Simón
- Servicio de Hematología, Hospital Universitario/Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain.
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Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity? Blood 2012; 120:4256-62. [PMID: 23007405 DOI: 10.1182/blood-2012-06-436725] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The best conditioning regimen before allogeneic transplantation for high-risk diffuse large B-cell lymphoma (DLBCL) remains to be clarified. We analyzed data from 396 recipients of allotransplants for DLBCL receiving myeloablative (MAC; n = 165), reduced intensity (RIC; n = 143), or nonmyeloablative conditioning (NMAC; n = 88) regimens. Acute and chronic GVHD rates were similar across the groups. Five-year nonrelapse mortality (NRM) was higher in MAC than RIC and NMAC (56% vs 47% vs 36%; P = .007). Five-year relapse/progression was lower in MAC than in RIC/NMAC (26% vs 38% vs 40%; P = .031). Five-year progression-free survival (15%-25%) and overall survival (18%-26%) did not differ significantly between the cohorts. In multivariate analysis, NMAC and more recent transplant year were associated with lower NRM, whereas a lower Karnofsky performance score (< 90), prior relapse resistant to therapy, and use of unrelated donors were associated with higher NRM. NMAC transplants, no prior use of rituximab, and prior relapse resistant to therapy were associated with a greater risk of relapse/progression. In conclusion, allotransplantation with RIC or NMAC induces long-term progression-free survival in selected DLBCL patients with a lower risk of NRM but with higher risk of lymphoma progression or relapse.
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