Cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non-Hodgkin's lymphoma: a dose-finding study.

Wheeler, Catherine; Antin, Joseph H.; Churchill, W. Hallowell; Come, S. E.; Smith, Brian R.; Bubley, Glenn J.; Rosenthal, David S.; Rappaport, Jamie M.; Ault, Kenneth A.; Schnipper, Lowell E.

doi:10.1200/jco.1990.8.4.648

Cited by 148 publications

(45 citation statements)

References 15 publications

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“…These transplant protocols have been published. [10][11][12][13][14] Quality of life instruments Patients were surveyed by mail before hospital admission and at 6 and 12 months post HCT. The survey solicited qualitative information on symptoms, self-assessment of health, feelings about the transplantation procedure and sense of recovery after transplantation.…”

Section: Patientsmentioning

confidence: 99%

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

Andorsky

Loberiza

Lee

2006

Bone Marrow Transplant

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Previous studies of quality of life (QOL) note compromised QOL after stem cell transplantation (HCT), but do not usually consider the impact of pre-transplantation deficits in QOL on post transplantation outcomes. To examine these associations, multivariate models for six self-reported QOL outcomes at 6 and 12 months were constructed, considering pre-transplantation clinical status and QOL, and subsequent clinical events. Outcomes measured overall subjective health, social functioning and agreement with statements such as 'Life has returned to normal.' Of 320 autologous and allogeneic HCT recipients who completed pre-transplantation surveys, 197 completed 6-month surveys and 175 completed 12-month surveys. Pre-transplantation overall health and mental health were independent predictors of all QOL outcomes at 6 months. Baseline physical health was also predictive of four of six outcomes at 12 months. In contrast, disease risk was predictive only of enjoying normal activities at 6 months. Relapse and chronic graft-versus-host disease were associated with poorer QOL. In conclusion, pretransplantation self-reported physical and mental health are more strongly associated with QOL after HCT than commonly noted baseline clinical predictors such as age and disease risk. Measurement of baseline QOL can help place the effects of the transplantation procedure in context.

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Section: Patientsmentioning

confidence: 99%

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

Andorsky

Loberiza

Lee

2006

Bone Marrow Transplant

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“…Doses greater than 600 mg/m 2 are not well tolerated with a higher risk of development of posttransplant noninfective pulmonary complications, marked mucositis, and increased cases of infection. [1][2][3][4][5][6] In terms of efficacy, whether CEB or BEAM produces better survival outcome is unclear. There is a wide range of percentages of patients achieving complete remission in both the CEB and BEAM.…”

mentioning

confidence: 99%

High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma

Wang

Chen

Corringham

et al. 2004

Bone Marrow Transplant

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, 72 patients with non-Hodgkin's lymphoma or Hodgkin's disease underwent high-dose chemotherapy with autologous stem cell transplant conditioned with either cyclophosphamide, etoposide, carmustine (CEB) or carmustine, etoposide, cytarabine, melphalan (BEAM) at a single institution. In all, 52 patients received CEB and 20 patients received the BEAM regimen. Patient characteristics that were significantly different between the two groups are tumor grade and extranodal involvement (P ¼ 0.0196, 0.0341, respectively). Regimen-related toxicities examined yielded only diarrhea occurring at a higher rate in the BEAM group (81 vs 51%, P ¼ 0.0026), although cases were milder (92 vs 57%). Patients treated with CEB developed mucositis at a slightly higher rate (79%) than patients treated with BEAM (75%), but this difference did not reach statistical significance. However, the mucositis that occurred within the BEAM group was predominately mild (67%) in contrast to the predominance of moderate to severe cases in the CEB group (74%). In addition, patients treated with CEB required growth factor support for a longer time than patients treated with BEAM (P ¼ 0.0399). Response rates were high in both groups, with trends favoring the BEAM group. Overall survival was higher after treatment with BEAM than with CEB (84 vs 60%). A subset of patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) have been treated with highdose chemotherapy with autologous stem cell transplant (HDC-ASCT). HDC regimens used include cyclophosphamide, etoposide, carmustine (BCNU) (CEB) or BCNU, etoposide, cytarabine (Ara-C), and melphalan (BEAM). In the past, CEB has been more commonly used at our institution; however, in recent years, oncologists are increasingly choosing BEAM to treat patients. The increased use of BEAM emerges from the belief that reduced toxicities are associated with this regimen, namely less mucositis, infection, and BCNU pulmonary fibrosis. A higher dose of BCNU (600 mg/m 2 ) is given as part of the CEB regimen than that given in the BEAM regimen (300 mg/m 2 ). Doses greater than 600 mg/m 2 are not well tolerated with a higher risk of development of posttransplant noninfective pulmonary complications, marked mucositis, and increased cases of infection. [1][2][3][4][5][6] In terms of efficacy, whether CEB or BEAM produces better survival outcome is unclear. There is a wide range of percentages of patients achieving complete remission in both the CEB and BEAM. 2,3,[7][8][9] Overall survival at 5 years seems comparable at 44-53% for CEB patients and 41-55% for BEAM patients. 3,[8][9][10][11] Progression-free survival ranges from 38 to 450% for the CEB group and from 35 to 69% for the BEAM group in various studies. [2][3][4][7][8][9]11 Data directly comparing CEB and BEAM regimens are scarce. In this paper, we present the results of a retrospective study on the toxicity, efficacy, and cost issues associated with the use of CEB and BEAM in patients with NHL or HD. Patients and methods Patient selectionA total of 86 patien...

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“…High-dose therapy with autologous bone marrow (ABMT) or peripheral blood stem cell (PBSC) support is increasingly used in the treatment of patients with poor prognosis Hodgkin's disease (Jagannath et al, 1989;Wheeler et al, 1990;Reece et al, 1991;Chopra et al, 1993;Linch et al, 1993). Initial studies largely focused on the treatment of patients with primary refractory or multiply relapsed Hodgkin's disease, but, as this modality of therapy became more widely accepted, it has frequently been used at the time of first relapse.…”

mentioning

confidence: 99%

High-dose BEAM chemotherapy with autologous haemopoietic stem cell transplantation for Hodgkin’s disease is unlikely to be associated with a major increased risk of secondary MDS/AML

et al. 1999

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SummaryHodgkin's disease is curable in the majority of patients, although a proportion of patients are resistant to or relapse after initial therapy. High-dose therapy with autologous stem cell support has become the standard salvage therapy for patients failing chemotherapy, but there have been reports of a high incidence of myelodysplasia/acute myeloid leukaemia (MDS/AML) following such treatment. Patients who receive such therapy form a selected group, however, who have already been subjected to other leukaemogenic factors, such as treatment with alkylating agents. In order to ascertain the true risk of MDS/AML, comparison must be made with other patients subjected to the same risks but not undergoing transplantation. We report a retrospective comparative study of 4576 patients with Hodgkin's disease from the BNLI and UCLH Hodgkin's databases, which includes 595 patients who have received a transplant. Statistical analysis including Cox's proportional hazards multivariate regression model with time-dependent covariates was employed. This analysis reveals that the risk of developing MDS/AML was dominated by three factors, namely quantity of prior therapy (relative risk [RR] 2.01, 95% confidence intervals [CI] 1.49-2.71, for each treatment block, P < 0.0001) and whether the patient had been exposed to MOPP (RR 3.61, 95% CI 1.64-7.95, P = 0.0009) or lomustine chemotherapy (RR 4.53, 95% CI 1.96-10.44, P = 0.001). Following adjustment for these factors in the multivariate model the relative risk associated with transplantation was 1.83 (95% CI 0.66-5.11, P = 0.25). This study provides no evidence of a significantly increased risk of MDS/AML associated with BEAM therapy and autologous transplantation in Hodgkin's disease. Concern over MDS/AML should not mitigate against the timely use of this treatment modality.

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Cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non-Hodgkin's lymphoma: a dose-finding study.

Cited by 148 publications

References 15 publications

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma

High-dose BEAM chemotherapy with autologous haemopoietic stem cell transplantation for Hodgkin’s disease is unlikely to be associated with a major increased risk of secondary MDS/AML

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