Autologous Transplantation for Diffuse Aggressive Non-Hodgkin’s Lymphoma in Patients Never Achieving Remission: A Report from the Autologous Blood and Marrow Transplant Registry

Summary:The ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) regimen has been shown to be effective as an active salvage therapy for lymphoma.Mobilizing stem cells following ESHAP should decrease time to transplantation by making separate mobilizing chemotherapy (MC) unnecessary, while controlling a patient's lymphoma. We therefore assessed the mobilization potential of ESHAP plus G-CSF in 26 patients (ESHAP group) with non-Hodgkin's lymphoma (NHL) and compared these results with those of 24 patients with NHL who received high-dose (4 g/m 2 l) cyclophosphamide (HDCY) as MC (HDCY group). The age, sex, and radiotherapy to the axial skeleton were well matched between groups, but the number of patients with poor mobilization predictors was higher in the ESHAP group. Significantly higher numbers of CD34 þ cells ( Â 10 6 /kg) (17.1718.8 vs 5.875.0, P ¼ 0.03) and apheresis day 1 CD34 þ cells ( Â 10 6 /kg) (5.576.6 vs 1.772.0, P ¼ 0.014) were collected from the ESHAP group than from the HDCY group, and the number of patients who achieved an optimal CD34 þ cell target of 5 Â 10 6 /kg was higher in the ESHAP group (81 vs 50%, P ¼ 0.022). Log-rank test revealed that time to target peripheral blood progenitor cell collection (X5 Â 10 6 /kg) was shorter in the ESHAP group (P ¼ 0.007). These results indicate that ESHAP plus G-CSF is an excellent mobilization regimen in patients with relapsed and poor-risk aggressive NHL. Bone Marrow Transplantation (2005) 35, 449-454.

mentioning

confidence: 99%

ESHAP plus G-CSF as an effective peripheral blood progenitor cell mobilization regimen in pretreated non-Hodgkin's lymphoma: comparison with high-dose cyclophosphamide plus G-CSF

Lee

et al. 2005

“…28 For relapse/progression, disease status is an important variable, as chemorefractory disease before allo-HCT is the strongest adverse prognostic factor. [6][7][8][9][10][11][12][13][14][15][16][17]25,28,34,35 Other factors that have been associated with increased risk of relapse are increased age (440 years old), 16,17 relapse occurring o12 months after initial treatment, 26 and use of other sources of stem cells than peripheral blood stem cells (PBSC). 35 Interestingly, no study to date has revealed any association of cGVHD with risk of relapse, possibly reflecting a minor role of immunological mechanism in the response of DLBCL patients to allo-HCT.…”

Section: Prognostic Factors For Outcome After Allo-sct In Patients Wimentioning

confidence: 99%

“…6 This approach is most effective in those with chemosensitive disease 7 and is associated with prolonged survival in B40% of patients. 8,9 However, patients who relapse within 12 months of initial treatment with a rituximab-containing regimen and those who are resistant to salvage treatment or relapse after an auto-HCT have a poor prognosis with a median survival of less than a year. 10,11 Allogeneic haematopoietic progenitor cell transplantation (allo-HCT) increasingly has been used as salvage treatment for these patients.…”

Section: Introductionmentioning

confidence: 99%

The role of allogeneic haematopoietic progenitor cell transplantation in patients with diffuse large B-cell non-Hodgkin lymphomas (DLBCL)

Papageorgiou

Cwynarski

Kottaridis

2013

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.

“…These patients have a poor prognosis, even with autoSCT, [46][47][48][49] although recently a number of groups have demonstrated that autoSCT can effectively salvage about 50% of patients sensitive to second-line chemotherapy. [50][51][52] Preliminary data suggest that alloSCT may be effective for patients with induction failure, 19,31 although the effect of chemosensitivity has not been formally assessed in this population.…”

Section: When To Transplant?mentioning

confidence: 99%

Why aren't we performing more allografts for aggressive non-Hodgkin's lymphoma?

Mollee

Lazarus

Lipton

2003

Summary:Allogeneic stem cell transplantation has an underappreciated role in the management of intermediate-grade non-Hodgkin's lymphoma. It provides several advantages over autologous stem cell transplantation including provision of a lymphoma-free graft, reduced rates of secondary myelodysplastic syndrome and leukemia, and a potentially curative graft-versus-lymphoma effect. When applied to chemosensitive patients, the lower relapse rates and reasonable long-term outcomes make allogeneic transplantation a promising therapy to pursue. Patient populations, such as those with bone marrow involvement or very high-risk disease, can be identified as having suboptimal outcomes after autotransplantation and may benefit from such an approach. While the exact role of allogeneic stem cell transplantation remains to be determined, broad recommendations can be suggested for the management of patients with intermediate-grade lymphoma. New approaches to allogeneic transplantation, including the use of matched-unrelated donors and reduced-intensity conditioning regimens, may expand the applicability of this potentially curative modality. Bone Marrow Transplantation (2003) 31, 953-960.