scholarly journals High-dose myeloablative radioimmunotherapy of mantle cell non-hodgkin lymphoma with the iodine-131-labeled chimeric anti-CD20 antibody C2B8 and autologous stem cell support

Cancer ◽  
2002 ◽  
Vol 94 (S4) ◽  
pp. 1363-1372 ◽  
Author(s):  
Thomas M. Behr ◽  
Frank Griesinger ◽  
Joachim Riggert ◽  
Stefan Gratz ◽  
Martin B�h� ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Dose ◽  
Stem Cell Support ◽  
Non Hodgkin Lymphoma ◽  
Mantle Cell ◽  
Iodine 131 ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Cell Support ◽  
Myeloablative Radioimmunotherapy

Follow-up of relapsed B-cell lymphoma patients treated with iodine-131-labeled anti-CD20 antibody and autologous stem-cell rescue.

1998 ◽  
Vol 16 (10) ◽  
pp. 3270-3278 ◽  
Author(s):  
S Y Liu ◽  
J F Eary ◽  
S H Petersdorf ◽  
P J Martin ◽  
D G Maloney ◽  
...  
Keyword(s):  
Stem Cell ◽  
B Cell ◽  
Radiation Doses ◽  
Stem Cell Support ◽  
Stem Cell Rescue ◽  
Iodine 131 ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Cell Support

PURPOSE Radioimmunotherapy (RIT) is a promising treatment approach for B-cell lymphomas. This is our first opportunity to report long-term follow-up data and late toxicities in 29 patients treated with myeloablative doses of iodine-131-anti-CD20 antibody (anti-B1) and autologous stem-cell rescue. PATIENTS AND METHODS Trace-labeled biodistribution studies first determined the ability to deliver higher absorbed radiation doses to tumor sites than to lung, liver, or kidney at varying amounts of anti-B1 protein (0.35, 1.7, or 7 mg/kg). Twenty-nine patients received therapeutic infusions of single-agent (131)I-anti-B1, given at the protein dose found optimal in the biodistribution study, labeled with amounts of (131)I (280 to 785 mCi [10.4 to 29.0 GBq]) calculated to deliver specific absorbed radiation doses to the normal organs, followed by autologous stem-cell support. RESULTS Major responses occurred in 25 patients (86%), with 23 complete responses (CRs; 79%). The nonhematopoietic dose-limiting toxicity was reversible cardiopulmonary insufficiency, which occurred in two patients at RIT doses that delivered > or = 27 Gy to the lungs. With a median follow-up time of 42 months, the estimated overall and progression-free survival rates are 68% and 42%, respectively. Currently, 14 of 29 patients remain in unmaintained remissions that range from 27+ to 87+ months after RIT. Late toxicities have been uncommon except for elevated thyroid-stimulating hormone (TSH) levels found in approximately 60% of the subjects. Two patients developed second malignancies, but none have developed myelodysplasia (MDS). CONCLUSION Myeloablative (131)I-anti-B1 RIT is relatively well tolerated when given with autologous stem-cell support and often results in prolonged remission durations with few late toxicities.

scholarly journals Myeloablative Anti-CD20 Radioimmunotherapy +/- High-Dose Chemotherapy Followed by Autologous Stem Cell Support for Relapsed/Refractory B-Cell Lymphoma Results in Excellent Long-Term Survival

Oncotarget ◽  
2013 ◽  
Vol 4 (6) ◽  
pp. 899-910 ◽  
Author(s):  
Julia Y Wagner ◽  
Kathleen Schwarz ◽  
Susanne Schreiber ◽  
Burkhard Schmidt ◽  
Hans-Jürgen Wester ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Term Survival ◽  
Stem Cell Support ◽  
Anti Cd20 ◽  
Cell Support

Phase II Study of High Dose Outpatient Cyclophosphamide and Rituximab, without Stem Cell Support, for Low Grade and Mantle Cell Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2741-2741 ◽  
Author(s):  
Lode J. Swinnen ◽  
Richard J. Jones ◽  
Miah Jung ◽  
Ian W. Flinn
Keyword(s):  
Stem Cell ◽  
Mantle Cell Lymphoma ◽  
Phase Ii Study ◽  
Cell Lymphoma ◽  
Outpatient Setting ◽  
High Dose ◽  
Low Grade ◽  
Stem Cell Support ◽  
Mantle Cell ◽  
Cell Support

Abstract Background: High dose cyclophosphamide and rituximab may be as or more effective than traditional myeloablative regimens, and less toxic. Prior work at our institution has shown that stem cell support is unnecessary after high-dose cyclophosphamide, in patients treated for aplastic anemia. Although initial response rates to myeloablative chemotherapy and autologous stem cell transplant for low grade lymphomas are high, eventual disease relapse is frequent, and both short and long term toxicities are substantial. One possible reason for the failure of therapy is the re-infusion of tumor cells with the stem cell product. Since high-dose cyclophosphamide will not eradicate stem cells, stem cell support should not be necessary, obviating the risk of reinfusing lymphoma cells. This phase II study was undertaken to determine the safety and efficacy of this approach in low grade and mantle cell lymphoma. Patients and Methods: Eligible lymphomas included chronic lymphocytic leukemia/small lymphocytic lymphoma, marginal zone, follicular grade I or II, and mantle cell lymphoma. Eligibility criteria included age ≥18 years, platelet count ≥75,000/mm3, WBC ≥3,000/mm3, bone marrow involvement ≤10%, and at least a partial response to the most recent prior therapy. Treatment consisted of rituximab 375 mg/m2 on days 1, 4, 8, and 11 followed by cyclophosphamide 50 mg/kg/day IV daily for 4 days, given on days 15–18, pegfilgrastim 6 mg on day 20, and rituximab 375 mg/m2 on days 45 and 52. All treatment was given in an outpatient setting with close monitoring, and without planned hospitalization. Results: As of August 6, 2006, forty-four patients (31M:13F), median age 55 years (range 24–70 ) have been accrued, with the following histologies: CLL/SLL (n=3), follicular lymphoma grade I or II (n=19), marginal zone lymphoma (n=1), and mantle cell lymphoma (n=21). 36 of the 44 patients have completed high dose cyclophosphamide and rituximab. Twenty four patients had received only 1 previous regimen, generally 4–6 cycles of R-CHOP to maximal response immediately prior to study enrollment. On completion of therapy, 26 (72%) patients had CR, and 10 (28%) patients maintained PR. Median follow up from completion of therapy is 12 months (range 2–34 months). Three patients have had disease progression, at a median of 13 months (range, 6–15 months). Of the 17 patients with mantle cell lymphoma, none have had disease progression. All patients recovered counts rapidly: neutrophils > 500/mm3 at a median of 10 days following cyclophosphamide (range 7–17), and platelets > 20,000/mm3 at 9 days (range 0–23). The most common grade 3 or 4 non-hematologic toxicities included pain (21%), nausea and vomiting (6%), infection (6%), abnormal LFT (3%), syncope (3%). Nine patients required a period of hospitalization for management of neutropenic fever, 6 for other problems. There have been no fatal toxicities. Conclusions: High-dose cyclophosphamide and rituximab, without stem cell support, can be given safely to patients with low grade and mantle cell lymphoma who have received prior chemotherapy. Toxicity is significantly lower than traditional myeloablative autologous transplant regimens, the risk of tumor cell reinfusion is avoided, and the option of a later myeloablative allogeneic transplant in the event of relapse is not compromised. This treatment was administered safely in an outpatient setting, and early efficacy results are encouraging.

scholarly journals Long-term progression-free survival of mantle cell lymphoma after intensive front-line immunochemotherapy with in vivo–purged stem cell rescue: a nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group

Blood ◽  
2008 ◽  
Vol 112 (7) ◽  
pp. 2687-2693 ◽  
Author(s):  
Christian H. Geisler ◽  
Arne Kolstad ◽  
Anna Laurell ◽  
Niels S. Andersen ◽  
Lone B. Pedersen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Stem Cell Support ◽  
Mantle Cell ◽  
Cell Support

AbstractMantle cell lymphoma (MCL) is considered incurable. Intensive immunochemotherapy with stem cell support has not been tested in large, prospective series. In the 2nd Nordic MCL trial, we treated 160 consecutive, untreated patients younger than 66 years in a phase 2 protocol with dose-intensified induction immunochemotherapy with rituximab (R) + cyclophosphamide, vincristine, doxorubicin, prednisone (maxi-CHOP), alternating with R + high-dose cytarabine. Responders received high-dose chemotherapy with BEAM or BEAC (carmustine, etoposide, cytarabine, and melphalan/cyclophosphamide) with R-in vivo purged autologous stem cell support. Overall and complete response was achieved in 96% and 54%, respectively. The 6-year overall, event-free, and progression-free survival were 70%, 56%, and 66%, respectively, with no relapses occurring after 5 years. Multivariate analysis showed Ki-67 to be the sole independent predictor of event-free survival. The nonrelapse mortality was 5%. The majority of stem cell products and patients assessed with polymerase chain reaction (PCR) after transplantation were negative. Compared with our historical control, the Nordic MCL-1 trial, the event-free, overall, and progression-free survival, the duration of molecular remission, and the proportion of PCR-negative stem cell products were significantly increased (P < .001). Intensive immunochemotherapy with in vivo purged stem cell support can lead to long-term progression-free survival of MCL and perhaps cure. Registered at www.isrctn.org as #ISRCTN 87866680.

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