High-dose cyclophosphamide followed by autologous peripheral blood progenitor cell transplantation improves the salvage treatment for persistent or sensitive relapsed malignant lymphoma

Abstract

Trials have demonstrated that high-dose escalation followed by autologous transplantation can promote better long-term survival as salvage treatment in malignant lymphomas. The aim of the present nonrandomized clinical trial was to demonstrate the role of high-dose cyclophosphamide (HDCY) in reducing tumor burden and also to determine the effectiveness of HDCY followed by etoposide (VP-16) and methotrexate (MTX) in Hodgkin s disease plus high-dose therapy with peripheral blood progenitor cell (PBPC) transplantation as salvage treatment. From 1998 to 2000, 33 patients with a median age of 33 years (13-65) affected by aggressive non-Hodgkin s lymphoma (NHL) (60.6%) or persistent or relapsed Hodgkin s disease (39.4%) were enrolled and treated using high dose escalation (HDCY + HDVP-16 plus HDMTX in Hodgkin s disease) followed by autologous PBPC transplantation. On an intention to treat basis, 33 patients with malignant lymphomas were evaluated. The overall median follow-up was 400 days (40-1233). Thirty-one patients underwent autografting and received a median of 6.19 x 10 6 /kg (1.07-29.3) CD34 + cells. Patients who were chemosensitive to HDCY (N = 22) and patients who were chemoresistant (N = 11) presented an overall survival of 96 and 15%, respectively (P<0.0001). Overall survival was 92% for chemosensitive patients and 0% for patients who were still chemoresistant before transplantation (P<0.0001). Toxicity-related mortality was 12% (four patients), related to HDCY in two cases and to transplant in the other two. HDCY + HDVP-16 plus HDMTX in only Hodgkin s disease followed by autologous PBPC proved to be effective and safe as salvage treatment for chemosensitive patients affected by aggressive NHL and Hodgkin s disease, with acceptable mortality rates related to sequential treatment.

Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas

“…(18, 21) However, this was not observed for NHL patients, with an OS of 41% and a PFS of 31%, similar to those reported in other studies (40 to 45%). (12,21,22) Although a higher prevalence of high-risk patients may explain the worse OS observed in the HL patients of this study, it should also have negatively impacted survival of NHL patients. This finding in a population of similar sociodemographic conditions with advanced disease treated under the same protocol and within the same institution highlights the different biology of both diseases and points to a need of different salvage strategies for each.…”

Brazilian experience using high-dose sequential therapy (HDS) followed by autologous hematopoietic stem cell transplantation (ASCT) for malignant lymphomas

“…22,[25][26][27] However, this was not observed for NHL patients, with OS of 41% and a PFS of 31%, similar to those observed by other authors, where OS ranged from 40%-45%. [13][14][15]27,28 This difference in response between HL and NHL patients has not been previously reported. Although the greater prevalence of high-risk patients can justify the worse survival observed in our HL patients, it should have also impacted survival of NHL patients.…”

“…The median day of leukapheresis after HDCY was +13 (Range: [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], with a median of three sessions (Range ). Twenty-one patients (27%) died after HDCY.…”

Frontline Therapy with Early Intensification and Autologous Stem Cell Transplantation versus Conventional Chemotherapy in Unselected High-Risk, Aggressive Non-Hodgkin’s Lymphoma Patients: A Prospective Randomized GEMOH Report

“…The use of high-dose sequential chemotherapy (HDS) followed by autologous stem cell transplantation (ASCT) has resulted in a significant improvement in both event-free and overall survival (OS) in patients with chemosensitive relapses of aggressive NHL [4, 5]. However, the role and timing of ASCT as up-front therapy in aggressive NHL remains unclear [6, 7].…”