Autologous Bone Marrow Transplantation as Compared with Salvage Chemotherapy in Relapses of Chemotherapy-Sensitive Non-Hodgkin's Lymphoma

Philip, Thierry; Guglielmi, Cesare; Hagenbeek, Anton; Somers, R.; Lelie, Hans van der; Bron, Dominique; Sonneveld, Pieter; Gisselbrecht, Christian; Cahn, Jean‐Yves; Harousseau, Jean‐Luc

doi:10.1056/nejm199512073332305

Cited by 2,241 publications

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“…[1][2][3] For such patients treated in this way a 5-year progression-free survival of approximately 50 and 46% can be expected. Individuals who relapse after highdose therapy, however, have a poor outlook due to a combination of disease chemoresistance, cumulative nonhaematological toxicity from previous therapy and sensitivity to further myelosuppression.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

et al. 1998

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We have performed a pilot study of MDR-1 gene transfer chain reaction (PCR) for vector-derived MDR-1 cDNA in patients receiving CD34-selected peripheral blood stem sequence in all cases. Analysis of peripheral blood and cell (PBSC) transplant for lymphoma. To ensure minimum bone marrow cells after transplant has, however, shown engraftment thresholds and facilitate CD34 purification, no evidence of in vivo gene transfer with a follow-up of 12, mobilisation of Ͼ2 × 10 6 CD34 cells/kg was a condition for 15 and 18 months. The effect of MDR-1 substrate drugs recruitment. Of 11 patients counselled for study entry, onlyhas not yet been tested as all patients remain in clinical five achieved this target in a single apheresis. In three conand radiological remission of their lymphoma. These senting patients, purified CD34 cells were exposed to results confirm the difficulty of achieving in vivo gene trans-A12M1 MDR-1 retroviral supernatant for 6 h, cryoprefer in human haemopoietic cells and indicate major logisserved then thawed and readministered following ablative tical constraints in PBSC mobilisation in patients with chemotherapy. No delay in engraftment was observed, relapsed and resistant disease in whom initial studies are although one patient received additional back-up cells.appropriate. Gene transfer was demonstrated by polymerase

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Section: Introductionmentioning

confidence: 99%

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

et al. 1998

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“…Despite these improvements in treatment, approximately 50% of patients with advanced disease will relapse or fail treatment with first line chemotherapy (Fisher et al, 1994;Canellos and Niedzwiecki, 2002;Coiffier et al, 2002). However, salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) in patients with chemo-sensitive HL and aggressive NHL can lead to long-term remission in 46 -55% of patients (Linch et al, 1993;Philip et al, 1995;Schmitz et al, 2002).…”

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confidence: 99%

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Waters

Cunningham

et al. 2005

Br J Cancer

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There is currently no standard salvage chemotherapy regimen in relapsed and refractory lymphoma. Gemcitabine is a novel nucleoside analogue, which acts synergistically with cisplatin both in vitro and in clinical studies. We evaluated the combination of gemcitabine, cisplatin and methylprednisolone (GEM-P) in 41 heavily pretreated patients with relapsed and refractory Hodgkin's and non-Hodgkin's lymphoma. The best-achieved response rate (RR) was 79% (95% CI 64 -91), with a complete RR of 21%. In patients with chemo-resistant disease, the RR was 63%. Myelosuppression was the main toxicity, the incidence of Grade 3 or 4 anaemia, neutropenia and thrombocytopenia was 17.1, 61.0 and 53.7% respectively. Only one patient had neutropenic sepsis and none of the patients suffered from haemorrhage. Grade 3 or 4 nonhaematological toxicity was minimal and stem cell mobilisation was not inhibited. GEM-P is an effective salvage regimen and its use prior to autologous stem cell transplant warrants further investigation.

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“…In 'aggressive' lymphoma, the benefit of such an approach has been demonstrated to be superior to conventional salvage chemotherapy in patients with relapsed disease (Philip et al, 1995) and has an accepted role in those patients whose disease is primary refractory to conventional therapy (Vose et al, 1993;Shipp et al, 1999). In follicular lymphoma, long-term freedom from recurrence may be achieved in those with recurrent disease (Freedman et al, 1999;Apostolidis et al, 2000;Hunault-Berger et al, 2002), and indeed in a randomized study an advantage in both PFS and OS was demonstrated (Schouten et al, 2003).…”

Section: Incorporation Of Rit Into Myeloablative Regimens With Progenmentioning

confidence: 99%

Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I131 tositumomab

Davies

2007

Oncogene

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Radioimmunotherapy, targeting the CD20 antigen, in B-cell lymphoma has clearly demonstrated efficacy and tolerability over the preceding 15 years. As a result, two products are available with Food and Drug Administration approval for marketing -Y 90 ibritumomab tiuxetan and I 131 tositumomab, given as the Zevalin and Bexxar therapeutic regimens, respectively. Both demonstrate high-response rates and durability of remission in the relapsed/refractory disease setting. Data are emerging regarding their utility as initial therapy, and furthermore, they are been investigated for use sequentially with chemotherapy, and in the myeloablative setting. As yet however, how to best use these agents in the clinical disease course remains uncertain.

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Autologous Bone Marrow Transplantation as Compared with Salvage Chemotherapy in Relapses of Chemotherapy-Sensitive Non-Hodgkin's Lymphoma

Abstract: As compared with conventional chemotherapy, treatment with high-dose chemotherapy and autologous bone marrow transplantation increases event-free and overall survival in patients with chemotherapy-sensitive non-Hodgkin's lymphoma in relapse.

Cited by 2,241 publications

References 30 publications

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I131 tositumomab

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