PURPOSE: To determine the toxicity and prognosis of patients with relapsed and refractory diffuse aggressive non-Hodgkin's lymphoma (NHL) who underwent an autologous bone marrow transplant (ABMT) using augmented preparative regimens, treated in a major cooperative group setting, and to examine prognostic factors for outcome. PATIENTS AND METHODS: Ninety-four patients with either chemosensitive (50 patients) or chemoresistant (44 patients) relapse, including 22 who failed induction chemotherapy, were treated with high-dose cyclophosphamide and etoposide with total-body irradiation (TBI) (67 patients) or an augmented carmustine (BCNU), cyclophosphamide, and etoposide (BCV) preparative regimen (27 patients) and an ABMT at 16 Southwest Oncology Group (SWOG) transplant centers. All relapsing patients were required to undergo a minimum of two courses of salvage therapy to determine chemosensitivity before transplant. Overall (OS) and progression-free survival (PFS) were determined and a Cox regression model was used to assess potential prognostic variables. RESULTS: Of the 94 eligible patients, there were 10 (10.6%) deaths before day 50 posttransplant because of infection (six deaths), hemorrhagic alveolitis (three deaths), or bleeding (one death). The median 3-year PFS and OS for the entire group was 33% and 44%. For those with chemosensitive disease the PFS and OS were 42% and 55%, whereas for those with chemoresistant disease the PFS and OS were 22% and 29%. The PFS and OS for those failing induction chemotherapy were 27% and 32%. The relapse rates within the first 3 years for the chemosensitive relapse, chemoresistant, and induction failure groups were 61%, 40%, and 59%, respectively. For both PFS and OS, only disease status at transplant was a significant factor in the multivariate Cox model. CONCLUSION: These results single institutional pilot trials exploring augmented preparative regimens. Patients undergoing transplantation for resistant disease, particularly those failing induction chemotherapy, appear to have an improved prognosis as compared with reports using standard preparative regimens. Therapies other than manipulation of standard preparative regimens appear to be required to decrease relapses following autotransplantation.
PURPOSE: To determine the toxicity and prognosis of patients with relapsed and refractory diffuse aggressive non-Hodgkin's lymphoma (NHL) who underwent an autologous bone marrow transplant (ABMT) using augmented preparative regimens, treated in a major cooperative group setting, and to examine prognostic factors for outcome. PATIENTS AND METHODS: Ninety-four patients with either chemosensitive (50 patients) or chemoresistant (44 patients) relapse, including 22 who failed induction chemotherapy, were treated with high-dose cyclophosphamide and etoposide with total-body irradiation (TBI) (67 patients) or an augmented carmustine (BCNU), cyclophosphamide, and etoposide (BCV) preparative regimen (27 patients) and an ABMT at 16 Southwest Oncology Group (SWOG) transplant centers. All relapsing patients were required to undergo a minimum of two courses of salvage therapy to determine chemosensitivity before transplant. Overall (OS) and progression-free survival (PFS) were determined and a Cox regression model was used to assess potential prognostic variables. RESULTS: Of the 94 eligible patients, there were 10 (10.6%) deaths before day 50 posttransplant because of infection (six deaths), hemorrhagic alveolitis (three deaths), or bleeding (one death). The median 3-year PFS and OS for the entire group was 33% and 44%. For those with chemosensitive disease the PFS and OS were 42% and 55%, whereas for those with chemoresistant disease the PFS and OS were 22% and 29%. The PFS and OS for those failing induction chemotherapy were 27% and 32%. The relapse rates within the first 3 years for the chemosensitive relapse, chemoresistant, and induction failure groups were 61%, 40%, and 59%, respectively. For both PFS and OS, only disease status at transplant was a significant factor in the multivariate Cox model. CONCLUSION: These results single institutional pilot trials exploring augmented preparative regimens. Patients undergoing transplantation for resistant disease, particularly those failing induction chemotherapy, appear to have an improved prognosis as compared with reports using standard preparative regimens. Therapies other than manipulation of standard preparative regimens appear to be required to decrease relapses following autotransplantation.
Authors: Hillard M Lazarus; Jeanette Carreras; Christian Boudreau; Fausto R Loberiza; James O Armitage; Brian J Bolwell; César O Freytes; Robert Peter Gale; John Gibson; Gregory A Hale; David J Inwards; Charles F LeMaistre; Dipnarine Maharaj; David I Marks; Alan M Miller; Santiago Pavlovsky; Harry C Schouten; Koen van Besien; Julie M Vose; Jacob D Bitran; Issa F Khouri; Philip L McCarthy; Hongmei Yu; Philip Rowlings; Derek S Serna; Mary M Horowitz; J Douglas Rizzo Journal: Biol Blood Marrow Transplant Date: 2008-12 Impact factor: 5.742
Authors: Patrick J Stiff; Joseph M Unger; James R Cook; Louis S Constine; Stephen Couban; Douglas A Stewart; Thomas C Shea; Pierluigi Porcu; Jane N Winter; Brad S Kahl; Thomas P Miller; Raymond R Tubbs; Deborah Marcellus; Jonathan W Friedberg; Kevin P Barton; Glenn M Mills; Michael LeBlanc; Lisa M Rimsza; Stephen J Forman; Richard I Fisher Journal: N Engl J Med Date: 2013-10-31 Impact factor: 91.245
Authors: Auayporn Nademanee; Stephen Forman; Arturo Molina; Henry Fung; David Smith; Andy Dagis; Cheuk Kwok; Dave Yamauchi; Anne-Line Anderson; Peter Falk; Amrita Krishnan; Mark Kirschbaum; Neil Kogut; Ryotaro Nakamura; Margaret O'donnell; Pablo Parker; Leslie Popplewell; Vinod Pullarkat; Roberto Rodriguez; Firoozeh Sahebi; Eileen Smith; David Snyder; Anthony Stein; Ricardo Spielberger; Jasmine Zain; Christine White; Andrew Raubitschek Journal: Blood Date: 2005-07-07 Impact factor: 22.113
Authors: Santosha A Vardhana; Craig S Sauter; Matthew J Matasar; Andrew D Zelenetz; Natasha Galasso; Kaitlin M Woo; Zhigang Zhang; Craig H Moskowitz Journal: Br J Haematol Date: 2016-12-16 Impact factor: 6.998
Authors: U Bode; M Zimmermann; O Moser; S Rutkowski; M Warmuth-Metz; T Pietsch; R D Kortmann; A Faldum; G Fleischhack Journal: J Neurooncol Date: 2014-09-02 Impact factor: 4.130
Authors: Ulrich J M Mey; Vandana Jha; John W Strehl; Marcus Gorschlueter; Christian Rabe; Eckfried Hoebert; Henning Popp; Ingo G H Schmidt-Wolf Journal: Ger Med Sci Date: 2007-06-19