Autotransplantation for relapsed or refractory non-Hodgkin’s lymphoma (NHL): long-term follow-up and analysis of prognostic factors

Summary:Relapse at sites of prior disease involvement accounts for the majority of treatment failures following highdose therapy and autologous transplantation for both Hodgkin's disease and non-Hodgkin's lymphoma. Several studies have demonstrated the utility of 'involvedfield' radiation as a treatment modality in this setting to minimize disease bulk prior to transplants, to reduce relapse rates at sites of prior disease involvement and to improve local control for disease resistant to highdose therapy. Other studies recommend caution due to potential toxicities including radiation-induced pneumonitis and secondary myelodysplasia. Further investigations are needed to better define the optimal extent, dose and timing of radiation in the setting of transplantation, as well as to identify those subsets of patients likely to be at a higher risk of radiation-induced morbidity.

Section: Discussionmentioning

confidence: 99%

Section: Use Of Ifrt In the Transplant Settingmentioning

confidence: 99%

Should involved-field radiation therapy be used as an adjunct to lymphoma autotransplantation?

Wadhwa

Shina

Schenkein

et al. 2002

“…Nonetheless, autoBMT is still associated with a moderately high risk of relapse. [1][2][3][4][5][6] Allogeneic bone marrow transplantation (alloBMT) is a potentially attractive option for the treatment of relapsed NHL, because it provides, in addition to the intensive therapy regimen, a graftversus-lymphoma effect that may reduce the risk of relapse. Its role in the management of patients with relapsed NHL must be explored because of higher treatment-related mortality and morbidity associated with acute and chronic graft-versus-host disease.…”

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confidence: 99%

Allogeneic or autologous bone marrow transplantation (BMT) for non-Hodgkin’s lymphoma (NHL): results of a provincial strategy

Schimmer

Jamal

Messner

et al. 2000

Summary:In 1986, the bone marrow transplant centers in Ontario agreed to a strategy for the treatment of patients with NHL. Suitable patients would undergo autotransplant but be referred for allotransplant if they had persistent marrow involvement or an inadequate marrow/stem cell harvest. Data of all patients were recorded in a database. We reviewed this database to compare these transplant modalities with respect to overall survival, rate of relapse and treatment-related mortality. Between January 1986 and August 1997, 429 patients underwent BMT for NHL -385 autotransplants and 44 allotransplants. Sixty-eight percent of patients received their transplant for aggressive NHL, while the others had indolent lymphoma. Three-year actuarial survival did not differ between allogeneic and autologous BMT: 71% vs 62%, respectively (P = 0.5330 by log-rank testing). Three-year actuarial rate of relapse was lower after allotransplant than autotransplant: 6% vs 41%, respectively (P = 0.0006 by log-rank testing). Treatmentrelated mortality was higher after allotransplant than autotransplant: 23% vs 6%, respectively (P = 0.001 by 2 analysis). For further comparison, autotransplant patients were randomly matched 2:1 with the allotransplant patients for age ± 5 years, disease status at BMT, disease histology, and year of BMT. In the matched comparison, survival did not differ (relative risk of death after allotransplant: 0.711 (95% CI: 0.309-1.637)). Relapse rate was significantly lower in the allotransplant group (relative risk of relapse for allotransplant: 0.190 (95% CI: 0.043-0.834)) and treatment-related mortality was not significantly different (relative risk for allotransplant: 1.425 (95% CI: 0.527-3.851)). In conclusion, a review of a provincial strategy for treatment of NHL, shows that survival is not different after allogeneic or autologous BMT, but the rate of relapse is lower after allotransplant. These data support continuing the current provincial strategy. Keywords: non-Hodgkin's lymphoma; autotransplant; allotransplant Autologous blood and marrow transplantation (autoBMT) is potentially curative in patients with chemotherapysensitive relapsed aggressive non-Hodgkin's lymphoma (NHL) 1-3 and improves survival compared with chemotherapy alone. 1,2,4 . Nonetheless, autoBMT is still associated with a moderately high risk of relapse. 1-6 Allogeneic bone marrow transplantation (alloBMT) is a potentially attractive option for the treatment of relapsed NHL, because it provides, in addition to the intensive therapy regimen, a graftversus-lymphoma effect that may reduce the risk of relapse. Its role in the management of patients with relapsed NHL must be explored because of higher treatment-related mortality and morbidity associated with acute and chronic graft-versus-host disease.Few studies have compared autoBMT and alloBMT for the treatment of relapsed NHL. [7][8][9] In a review of 938 autotransplants and 122 allotransplants for relapsed aggressive NHL from the European BMT (EBMT) registry, progression-free survival betw...

“…Keywords: lymphoma; transplant; salvage; chemotherapy; chemosensitivity Sensitivity to salvage chemotherapy is one of the strongest predictors of outcome after high-dose therapy with autologous bone marrow or peripheral blood stem cell transplantation (ABMT) in relapsed or refractory non-Hodgkin's lymphoma. [1][2][3][4][5][6] Numerous salvage chemotherapy regimens have been used to reduce disease bulk and test chemosensitivity, but no single regimen appears superior. In general, initial response rates of 30-50% with salvage therapy are attainable.…”

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confidence: 99%

“…[1][2][3][4][5][6] Numerous salvage chemotherapy regimens have been used to reduce disease bulk and test chemosensitivity, but no single regimen appears superior. In general, initial response rates of 30-50% with salvage therapy are attainable.…”

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confidence: 99%

‘Relative’ chemotherapy sensitivity: the impact of number of salvage regimens prior to autologous stem cell transplant for relapsed and refractory aggressive non-Hodgkin's lymphoma

Chen

Roitman

Tsang

et al. 2002

Summary:The purpose of the study was to assess the impact of number of salvage regimens needed to demonstrate chemotherapy sensitivity on relapse rates, survival, and toxicity following high-dose therapy and autologous bone marrow transplantation (ABMT) in relapsed or refractory non-Hodgkin's lymphoma. We retrospectively reviewed 136 patients with intermediate-grade lymphoma who underwent ABMT. All patients were treated with salvage therapy to maximum tumor reduction. Three quarters (102/136) of the patients received one salvage regimen, while 31 (23%) patients received two or more regimens. When compared to patients requiring у two regimens, patients requiring only one salvage regimen to demonstrate chemosensitivity were more likely to have a longer previous CR from initial therapy (CR у12 months in 47% vs 26%; P = 0.04) and to have attained CR with salvage (54% vs 16%; P = 0.001). Both median relapse-free survival (RFS) and overall survival (OS) have not yet been reached in patients receiving one salvage regimen (median follow-up 50.6 months). This is superior to the median RFS of 9.1 months (P = 0.004) and OS of 11.1 months in patients requiring уtwo regimens to demonstrate chemosensitivity (P = 0.002). Time to engraftment, toxic deaths and incidence of myelodysplasia were similar in the groups. The survival rate observed in patients requiring уtwo salvage regimens, although inferior to that of patients receiving a single salvage regimen, are still generally superior to results in the literature for patients treated with chemotherapy alone without ABMT. We conclude that high-dose therapy with ABMT is appropriate for lymphoma patients even when disease reduction requires repeated numbers of salvage regimens. Keywords: lymphoma; transplant; salvage; chemotherapy; chemosensitivity Sensitivity to salvage chemotherapy is one of the strongest predictors of outcome after high-dose therapy with autologous bone marrow or peripheral blood stem cell transplantation (ABMT) in relapsed or refractory non-Hodgkin's lymphoma. [1][2][3][4][5][6] Numerous salvage chemotherapy regimens have been used to reduce disease bulk and test chemosensitivity, but no single regimen appears superior. In general, initial response rates of 30-50% with salvage therapy are attainable. 7-16 Those who do not respond or have disease progression with first-line salvage tend to fare poorly with high-dose therapy and may proceed to second-or even third-line salvage treatment with the hope of qualifying for high-dose therapy and ABMT. This approach may seem reasonable, particularly in young patients with good performance status, but has not been validated in the literature. Requiring more than one salvage regimen to attain an adequate response may reflect greater intrinsic drug resistance or may identify patients with a less favorable natural history predicting for transplant failure, regardless of the disease status ultimately achieved. Hence, the use of multiple salvage regimens pre-ABMT raises concerns of greater risk-to-benefit ratio and poor uti...