Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine‐based high‐dose chemotherapy regimen

Abstract

SummaryHigh‐dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third‐generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR‐HL accrued into a prospective registry‐based study. Application of FEAM resulted in a 2‐year progression‐free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64–0·81] with median PFS, overall survival and time to progression yet to be reached. The 2‐year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12–0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose (18 FFDG)‐uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had 18 FFDG‐positrin emission tomography‐positive lesions before HDT, the 2‐year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12–0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR‐HL patients typically pre‐exposed to lung‐damaging treatments.

Hodgkin’s Lymphoma - evaluation of patients submitted to Autologous transplantation of hematopoietic cells in the Hematology Service of the Hospital Walter Cantídio – Fortaleza, Brazil.

“…7,8,9,10,11,12 The present analysis of transplanted patients at UTMO/HUWC/UFC shows a young population (mean age of 28 years), with a predominance of localized disease (I+II), mostly B, initially treated with standard regimen (ABVD) and who did not respond or had recurrence, becoming candidates for a new treatment regimen and the possibility of BMT indication. However, 50.0% of them came to transplantation in partial remission of the lymphoma, showing much lower results when considering the patient coming to the BMT in complete remission (64.7% vs. 35.3%).…”

Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning

“…[49,50] (Table 3) TRM rates were low in both studies and ranged from 2% to 3%, with key toxicities including mucositis and GI toxicities. Overall, the efficacy of FEAM appears promising with a manageable safety profile and no late toxicities recorded to date.…”

“…[49,50] Unlike other nitrosoureas, fotemustine has shown no significant pulmonary toxicity and may therefore be a reasonable alternative to carmustine.…”

64. Acute flaccid paralysis by Enterovirus D68 infection: First Italian description on adult patient and role of electrophysiology

“…She received four cycles of the R-DHAP (rituximab, dexamethasone, cytarabine, cisplatin) treatment regimen (20), with a good response. In June 2013, she underwent an auto-HSCT after receiving the FEAM (fotemustine, etoposide, cytarabine, melphalan) conditioning regimen (21). Six months after the auto-HSCT, owing to progression of the disease in the right humerus, she received local radiotherapy (total dose 30 Gy) and four cycles of the IEV protocol (epirubicin, ifosfamide, and etoposide) (22), which yielded a partial response.…”