OUTCOME OF PATIENTS WITH AGGRESSIVE B-CELL LYMPHOMA WHO FAILED TO PROCEED TO OR RELAPSED AFTER HIGH DOSE CHEMOTHERAPY AND AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANTATION

2019 ◽  
Vol 37 ◽  
pp. 435-435
Author(s):  
J. Romejko-Jarosinska ◽  
E. Paszkiewicz-Kozik ◽  
L. Popławska ◽  
L. Targonski ◽  
M. Szymanski ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Autologous Hematopoietic Cell Transplantation ◽  
Aggressive B Cell Lymphoma

Efficacy and Safety of Conditioning Treatment Using Bendamustine in Autologous Hematopoietic Cell Transplantation in Heavily Pretreated Patient with Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4537-4537
Author(s):  
Malgorzata Krawczyk-Kulis ◽  
Anna Kopinska ◽  
Iwona Grygoruk-Wisniowska ◽  
Slawomira Kyrcz-Krzemien
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Conditioning Treatment ◽  
Cd34 Cells ◽  
Autologous Hematopoietic Cell Transplantation

Abstract Abstract 4537 Most of lymphoma patients are chemo- and radiosensitive. Using a conventional therapy we can cure about 50% of patients (pts). Unfortunately the rests achieved only partial remission or have a rapid relapse after treatment. These pts are a real challenge for nowadays hematology. Till now there is not a recommended scheme of therapy. Using high dose chemotherapy with autologous hematopoietic cell transplantation (AHCT) is the most popular one. During the last year in our Department we have been started using BeEAM as the conditioning treatment, and the results of a single centre observation are presented now. Material and Methods Actually: between April, 2011 and February, 2012 we conducted AHCT using BeEAM as conditioning treatment in 23 pts with lymphoma (18 pts with Hodgkin Lymphoma (HLy), 2pts with diffuse large B cell lymphoma (DLBCL), 2 pts with T cell lymphoma (TCL), 1 with follicular lymphoma (FL). There were 14 male and 9 female, with a median age of 37,6 (range 21–62 yrs). Ann Arbor staging at diagnosis was as follows: II-33%, III-50%, IV-17%; 83% of patients manifested B-symptoms. Clinical manifestation at diagnosis included: enlargement of the lymph nodes (n=18), bone marrow infiltration (n=2), lung infiltrates (n=3). Initially, all patients received at least 2 cycles of chemotherapy; in HLy all pts received ABVD, in non HLy- RCHOP. None of them achieved complete remission (CR). Partial response (PR), defined as the reduction of measurable disease by ≥50% without the appearance of any new lesions, achieved 11pts. The rests underwent high dose chemotherapy (HDT) followed by AHCT without remission (NR). Stem cells were collected from peripheral blood after IVE chemotherapy (Ifosfamide 3g/m2 iv in 1–3d, Etoposide200mg/m2 iv in 1–3d, Epirubicine 50mg iv in1d) and subsequent administration of G-CSF at a dose of 10ug/kg/d, starting from +5 day after chemotherapy till the last day of collection. Collections were performed using Optia Spectra. All pts collected the sufficient number of CD34+ cells for AHCT procedure. Conditioning regimens before AHCT consisted of BeEAM (Bendamustine 200mg/m2 in -8-7d, Etoposide 200mg/m2 in -6-3d, Ara-C 400mg/m2 in -6-3d, Melphalan 140mg/m2 in -2d). A median number of transplanted CD34+ cells was 5,58 (2,05–17,8×10∧6/kg). All except one pt successfully engrafted. 1 pt with Hly died within 8 day after transplantation due to infection. Hematopoietic recovery was as following: WBC count > 1,0×10∧9/L after median of 12 days (range 9–15 days),ANC> 0,5×10∧9/L after median of 13 days (range 9–16 days) and platelet count >20×10∧9/L after median of 13days (range 7–20 days). Results 3 pts died after AHCT. Two of them due to progression of the disease within 5 and 16 months after AHCT. Both were without remission before AHSCT. 1 pt died due to heart insufficient after 3 months after AHCT. The complications after transplantation procedure were rare and included mainly: bacterial infection in the upper respiratory tract (n=3), viral skin infection (n=1), oral mucositis (n=2). At the last contact, 19 pts are alive and 9 of them achieved CR, and 3 – stable disease. One pt underwent sibling alloHCT and 2 others will undergo alloHCT within 2 months. 4 pts with Hly were treated with anty CD 30+. Conclusion Autologous hematopoietic cell transplantation using IVE for mobilization and BeEAM as conditioning is effective treatment for lymphoma patients with refractory disease. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation

Blood ◽  
1998 ◽  
Vol 91 (2) ◽  
pp. 717-723 ◽  
Author(s):  
Laurie H. Sehn ◽  
Joseph H. Antin ◽  
Lawrence N. Shulman ◽  
Peter Mauch ◽  
Anthony Elias ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Large B Cell Lymphoma ◽  
Autologous Hematopoietic Cell Transplantation ◽  
Large B Cell

Abstract We performed a retrospective analysis of 35 patients with primary diffuse large B-cell lymphoma of the mediastinum treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) plus autologous hematopoietic cell transplantation to determine outcome and prognostic features for progression-free survival (PFS). Thirty-five patients with primary diffuse large B-cell lymphoma of the mediastinum in first response (complete remission [CR] or partial remission [PR]) with poor prognostic features, with primarily refractory disease, or with relapsed disease following conventional chemotherapy, were treated with CBV and autologous hematopoietic cell transplantation. PFS and overall survival were assessed by the Kaplan-Meier method. Patient characteristics before transplantation were examined by univariate analysis using the log-rank test and by Cox's proportional hazards regression analysis to determine predictors of PFS. Estimated 5-year PFS varied significantly with patient disease status at transplantation. Patients transplanted in first response had an estimated 5-year PFS rate of 83%, compared with 58% and 27% for primarily refractory and relapsed patients, respectively (P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapy-responsive disease had a significantly greater PFS rate than patients with chemotherapy-nonresponsive disease (risk ratio, 3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors were found to be significant on univariate or multivariate analysis. Patients with primary diffuse large B-cell lymphoma of the mediastinum can achieve prolonged PFS following high-dose chemotherapy and autologous hematopoietic cell transplantation. Outcomes are strongly correlated with disease status (first response v refractoryv relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation.

scholarly journals Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation

Blood ◽  
1998 ◽  
Vol 91 (2) ◽  
pp. 717-723
Author(s):  
Laurie H. Sehn ◽  
Joseph H. Antin ◽  
Lawrence N. Shulman ◽  
Peter Mauch ◽  
Anthony Elias ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hematopoietic Cell ◽  
High Dose ◽  
Large B Cell Lymphoma ◽  
Autologous Hematopoietic Cell Transplantation ◽  
Large B Cell

We performed a retrospective analysis of 35 patients with primary diffuse large B-cell lymphoma of the mediastinum treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) plus autologous hematopoietic cell transplantation to determine outcome and prognostic features for progression-free survival (PFS). Thirty-five patients with primary diffuse large B-cell lymphoma of the mediastinum in first response (complete remission [CR] or partial remission [PR]) with poor prognostic features, with primarily refractory disease, or with relapsed disease following conventional chemotherapy, were treated with CBV and autologous hematopoietic cell transplantation. PFS and overall survival were assessed by the Kaplan-Meier method. Patient characteristics before transplantation were examined by univariate analysis using the log-rank test and by Cox's proportional hazards regression analysis to determine predictors of PFS. Estimated 5-year PFS varied significantly with patient disease status at transplantation. Patients transplanted in first response had an estimated 5-year PFS rate of 83%, compared with 58% and 27% for primarily refractory and relapsed patients, respectively (P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapy-responsive disease had a significantly greater PFS rate than patients with chemotherapy-nonresponsive disease (risk ratio, 3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors were found to be significant on univariate or multivariate analysis. Patients with primary diffuse large B-cell lymphoma of the mediastinum can achieve prolonged PFS following high-dose chemotherapy and autologous hematopoietic cell transplantation. Outcomes are strongly correlated with disease status (first response v refractoryv relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation.

Immunoglobulin G Fc Polymorphism Is Correlated with Rituximab-Induced Neutropenia Following Autologous Hematopoietic Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 442-442
Author(s):  
Wen-Kai Weng ◽  
Sandra J. Horning ◽  
Robert S. Negrin ◽  
Ronald Levy
Keyword(s):  
B Cell ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hematopoietic Cell ◽  
Cell Depletion ◽  
B Cell Depletion ◽  
Grade 3 ◽  
Autologous Hematopoietic Cell Transplantation

Abstract Rituximab has been given following autologous hematopoietic cell transplantation (HCT) for recurrent or refractory B cell lymphoma with the goal of eradicating minimal residual disease. Our recent study showed that this is a feasible strategy although transient grade 3 or 4 neutropenia was observed in 51% of patients (Blood 103:777, 2004). We also reported that two IgG Fc receptor (FcγR) polymorphisms, FcγRIIIa 158 V/V and FcγRIIa 131 H/H genotypes, predict response to rituximab therapy in patients with follicular lymphoma, probably due to their role in the antibody-dependent cellular cytotoxicity (ADCC) (JCO 21:3940, 2003). In the current report, we correlated FcγR polymorphisms with clinical outcomes after post-transplant rituximab. A total of 35 patients with diffuse large cell (25 patients), mantle cell (3 patients), transformed (3 patients) or other (4 patients) subtypes of B cell lymphoma received high-dose therapy, autologous HCT and rituximab, administrated as 4-weekly infusions (375 mg/m2) starting around day 42 and 6 months after HCT. Genomic DNA was available for FcγR polymorphism analysis in 33 cases. For the FcγRIIIa polymorphism, 4 (12%) patients were homozygous valine/valine (158 V/V), 14 (42%) patients were heterozygous valine/phenylalanine (158 V/F) and 15 (46%) patients were homozygous phenylalanine/phenylalanine (158 F/F). For the FcγRIIa polymorphism, 8 (24%) patients were homozygous histidine/histidine (131 H/H), 16 (49%) patients were heterozygous histidine/arginine (131 H/R) and 9 (27%) patients were homozygous arginine/arginine (131 R/R). We did not find a correlation of either the FcγRIIIa V/F polymorphism or the FcγRIIa H/R polymorphism with time to relapse after HCT. But the small number of relapses limited our power. Although rituximab infusions were well tolerated in this group of patients, 32% of the treatment courses in this study were associated with rituximab-induced grade 3 or grade 4 neutropenia (ANC < 1000/μl), which was recorded in 51% of patients. These neutropenic episodes were not associated with infection and responded well to G-CSF treatment. The reason for this high incidence of rituximab-induced neutropenia is unclear. Among the 33 patients analyzed for FcγR polymorphisms, FcγRIIIa 158 V/V homozygotes experienced relatively greater neutropenia (V/V : 3/4, 75%; V/F: 8/14, 57%; F/F: 5/15, 33%). For the 57 treatment courses, the FcγRIIIa 158 V/V genotype was associated with a greater chance of rituximab-induced neutropenia, compared to F carriers (158 V/F and 158 F/F). The incidence of rituximab-induced neutropenia was 71% for V/V, 39% for V/F, 19% for F/F and 28% for F carriers (V/V vs F carriers, p = 0.035). In contrast, the FcγRIIa H/R polymorphism had no impact on rituximab-induced neutropenia. Although the mechanism of rituximab-induced neutropenia is unknown, this report implicates an FcγR-mediated process, such as ADCC. It is possible that B cell depletion by rituximab affects either directly or indirectly cytokine (e.g. G-CSF) production as a mechanism for neutropenia. It will be of great interest to study the correlation between FcγR polymorphisms and the prevalence and duration of B cell depletion after rituximab therapy in larger clinical studies both after HCT and in conjunction with other myelosupressive therapies.

scholarly journals Phase III Randomized Study of Rituximab/Carmustine, Etoposide, Cytarabine, and Melphalan (BEAM) Compared With Iodine-131 Tositumomab/BEAM With Autologous Hematopoietic Cell Transplantation for Relapsed Diffuse Large B-Cell Lymphoma: Results From the BMT CTN 0401 Trial

2013 ◽  
Vol 31 (13) ◽  
pp. 1662-1668 ◽  
Author(s):  
Julie M. Vose ◽  
Shelly Carter ◽  
Linda J. Burns ◽  
Ernesto Ayala ◽  
Oliver W. Press ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hematopoietic Cell ◽  
Large B Cell Lymphoma ◽  
Iodine 131 ◽  
Autologous Hematopoietic Cell Transplantation ◽  
Large B Cell

PurposeThis clinical trial evaluated standard-dose radioimmunotherapy with a chemotherapy-based transplantation regimen followed by autologous hematopoietic cell transplantation versus rituximab with the same regimen in patients with relapsed diffuse large B-cell lymphoma (DLBCL).Patients and MethodsPatients with chemotherapy-sensitive persistent or relapsed DLBCL were randomly assigned to receive iodine-131 tositumomab (dosimetric dose of 5 mCi on day −19 and therapeutic dose of 0.75 Gy on day −12), carmustine 300 mg/m2(day −6), etoposide 100 mg/m2twice daily (days −5 to −2), cytarabine 100 mg/m2twice daily (days −5 to −2), and melphalan 140 mg/m2(day −1; B-BEAM) or rituximab 375 mg/m2on days −19 and −12 and the same chemotherapy regimen (R-BEAM).ResultsTwo hundred twenty-four patients were enrolled, with 113 patients randomly assigned to R-BEAM and 111 patients assigned to B-BEAM. Two-year progression-free survival (PFS) rates, the primary end point, were 48.6% (95% CI, 38.6% to 57.8%) for R-BEAM and 47.9% (95% CI, 38.2% to 57%; P = .94) for B-BEAM, and the 2-year overall survival (OS) rates were 65.6% (95% CI, 55.3% to 74.1%) for R-BEAM and 61% (95% CI, 50.9% to 69.9%; P = .38) for B-BEAM. The 100-day treatment-related mortality rates were 4.1% (95% CI, 0.2% to 8.0%) for R-BEAM and 4.9% (95% CI, 0.8% to 9.0%; P = .97) for B-BEAM. The maximum mucositis score was higher in the B-BEAM arm (0.72) compared with the R-BEAM arm (0.31; P < .001).ConclusionThe B-BEAM and R-BEAM regimens produced similar 2-year PFS and OS rates for patients with chemotherapy-sensitive relapsed DLBCL. No differences in toxicities other than mucositis were noted.

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