Second autologous transplantation after failure of a first autologous transplant in 18 patients with non-Hodgkin's lymphoma

Abstract

High-dose chemotherapy and autologous marrow or peripheral stem cell support offers the best chance of cure in some subgroups of patients with non-Hodgkin's lymphoma (NHL). Less is known about the role of a second course of myeloablative chemotherapy in patients who relapse after a first autologous transplant. The aim of this retrospective study was to evaluate the disease outcome, morbidity and mortality associated with second autologous transplantation in patients with NHL. Between 1985 and 2001, 225 patients who had received autologous transplantation for NHL in two institutions in Lyon relapsed. Of these 225 patients 18 underwent a second autologous transplantation. The median age at second transplant was 41 years. There were six indolent lymphomas and 12 aggressive lymphomas. The median follow-up from the second transplant was 42 months. The OS rate at 2 and 5 years were 58 and 27%, respectively. The PFS rate at 2 and 5 years was 36%. Five patients are alive without disease 20 to 100 months after the second transplant. Seven patients died of disease recurrence. Four (22%) toxic deaths occurred: one of pulmonary fibrosis, one of fungal infection and cardiac failure and two of acute leukaemia. A minority of patients with NHL recurrence after a first transplant can be cured by a second course of myeloablative chemotherapy at the cost however of high-risk toxic death.

Second Autologous Stem Cell Transplantation for Relapsed Lymphoma after a Prior Autologous Transplant

“…In addition to the MSKCC series already mentioned (9), the MD Anderson Cancer Center (MDACC) (13) and The Ohio State group (14) each reported on 4 such patients. Two other retrospective studies with differing patient groups were recently reported as well (15, 16). A retrospective French study described 18 patients with a median age of 41 years, including 6 with indolent and 12 with a variety of aggressive histologies, including mantle cell lymphoma, T-cell lymphoma, and transformed lymphomas.…”

Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?

“…8,15,[31][32][33] Despite this limitation, several conclusions can be reached by analyzing these early studies. First, the treatment-related mortality (TRM) was higher than expected after an initial auto-HSCT and ranged from 11 to 40%.…”

“…The higher incidence of secondary tumors in long-term survivors after second auto-HSCT also was described in one of the studies with the longest posttransplant follow-up. 33 Despite the higher TRM associated with the second auto-HSCT, a select group of patients attained prolonged remissions.…”

Relapse of High-Grade Non-Hodgkin's Lymphoma After Autologous Stem Cell Transplantation: A Case Successfully Treated With Cyclophosphamide Plus Somatostatin, Bromocriptine, Melatonin, Retinoids, and ACTH

“…3 A minority can be cured by a second course of myeloablative chemotherapy at the cost, however, of high-risk toxicity. 4 With an association of cyclophosphamide, somatostatin, bromocriptine, retinoids, melatonin, and ACTH, we have documented a complete response in a patient who had a relapse of high-grade NHL 2 years after an auto-SCT.…”