Estimating late adverse events using competing risks after autologous stem‐cell transplantation in aggressive non‐Hodgkin lymphoma patients

Abstract

BACKGROUND Consolidative autologous stem‐cell transplantation (ASCT) is a valuable option in high‐risk or disease recurrence large‐cell non‐Hodgkin lymphoma patients (NHL); however, its long‐term toxicity must still be assessed. METHODS Among the 439 lymphoma patients transplanted at our institution from January 1, 1993, to January 1, 2002, 158 exhibited aggressive NHL. The median age of the patients was 46 years (range, 18–69), 98 males and 60 females. Ninety (57%) patients received first‐line ASCT. The median number of prior chemotherapy regimens was 2 (range, 1–10). Thirty‐eight (24%) patients received total body irradiation conditioning. Here we report the adverse events which occurred at least 30 days after ASCT and before disease recurrence. RESULTS After a median follow‐up of 3 years, the overall and disease‐free survival rates were 61% and 55%, respectively. Sixty‐eight late adverse events affected 43 (27%) patients, leading to a cumulative incidence of 34% at 3 years. Infections were the most frequent adverse events (n = 13), followed by neurologic (n = 12), pulmonary (n = 6), or cardiovascular (n = 4). Eight malignancies were diagnosed (six solid, two hematologic), leading to a cumulative incidence of 3.7% at 3 years. Taking into account the competing risks, multivariate analysis revealed that the number of progressions (relative risk [RR] = 2.68) and a mitoxantrone‐containing conditioning regimen (RR = 2.98) significantly increased the incidence of late toxicity. CONCLUSION ASCT is effective in patients with aggressive NHL with a poor prognosis. However, careful long‐term follow‐up of survivors is recommended because of the increase in malignant and nonmalignant toxicities. Cancer 2005. © 2005 American Cancer Society.

The impact of pre‐ and post‐transplantation positron emission tomography using 18‐fluorodeoxyglucose on poor‐prognosis lymphoma patients undergoing autologous stem cell transplantation

“…21,26,27 Transplantation Modalities Peripheral blood stem cell cryopreservation, thawing, and reinfusion procedures were performed according to standard guidelines. 28,29 Patients were treated with HDT and ASCT if they reached partial remission (PR), CR, or CRu after chemotherapy. They received a conditioning chemotherapy regimen with or without radiation therapy.…”

Non-malignant late effects in lymphoma patients treated with autologous hematopoietic stem cell transplantation

“…Previously, age and cardiac dysfunction were accepted as more restrictive, but today, the transplantation applied to older patients may lead to an increased incidence of impaired cardiac function (7-9). Ruiz-Soto et al (10) reported the rate of patients developing left ventricular dysfunction as 6% in their study, wherein they evaluated 493 patients with aggressive NHL who underwent AHSCT. Only 2% of these patients were reported as symptomatic.…”

“…Ruiz-Soto et al (10) followed 439 aggressive NHL patients who underwent AH-SCT for a median of 3 years after transplantation in terms of late complications. The number of the patients with late complications was 68, and renal failure was identified only in one patient.…”

Lower Genital Tract Precancer and Cancer in Hematopoietic Cell Transplant Survivors and the Role of HPV: A Systematic Review and Future Perspectives

“…Study characteristics are presented in Table 2 [27][28][29][30][31][32][33][34][35][36][37][38][39].…”