High-dose thiotepa, melphalan and carboplatin (TMCb) followed by autologous peripheral blood stem cell transplantation in patients with lymphoma – a retrospective evaluation

Abstract

Summary:The purpose of this evaluation was to investigate the efficacy of high-dose chemotherapy with thiotepa, melphalan, and carboplatin (TMCb), and of autologous peripheral blood stem cell (PBSC) infusion in patients with aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD). A total of 42 patients, 23 with intermediate-grade NHL and 19 with HD, received thiotepa (500 mg/m 2 ), melphalan (100 mg/m 2 ), and carboplatin (1050-1350 mg/m 2 ) followed by autologous PBSC infusion. Of 21 patients with more advanced disease, four had primary refractory disease, one was in complete remission (CR)-2, 11 were in first refractory relapse, and five were beyond first relapse. Of 21 patients with less advanced disease, two were in CR-1, four were in CR-2, and 15 were in first responding relapse. In all, 14 patients (33%) had received prior radiotherapy prohibiting a totalbody irradiation (TBI)-based conditioning regimen. The projected 2-year probabilities of survival, event-free survival (EFS), and relapse for all patients were 0.65, 0.60, and 0.21 (0.85, 0.80, and 0.10 for patients with less advanced disease and 0.47, 0.42, and 0.33 for patients with more advanced disease). The probability of nonrelapse mortality in the first 100 days was 0.12. Grade 3-4 regimen-related toxicities (RRT) occured in five of 42 (12%) patients and death due to grade-4 RRT occured in only one (2.5%) patient. These preliminary data suggest that 0.42% EFS in this study for advanced disease patients is highly encouraging and high-dose TMCb followed by autologous PBSC transplantation is well tolerated as well as an effective regimen in patients with intermediate-grade NHL or HD, and may be comparable to some previously used regimens including TBI-based regimens.

Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT

“…In keeping with published experience, [10][11][12][13][14][15][16][17][18][19][20] the main combination partners of TT were carmustine, melphalan, busulfan and cyclophosphamide. No significant differences for any safety or efficacy end point could be demonstrated between BEAM-and TT-based regimens for the whole population as well as for relatively large groups of the DLBCL, HL and FL subentities, except a significantly higher relapse risk with TT in the DLBCL CR/PR1 subset (which is not a standard indication for auto-SCT).…”

Treosulfan-fludarabine-thiotepa conditioning before allogeneic haemopoietic stem cell transplantation for patients with advanced lympho-proliferative disease. A single centre study

“…Progression rate (54%) remained the most important concern. With the aim of increasing anti‐tumour effect, we added thiotepa to the treosulfan–fludarabine combination in preparing high‐risk patients to haemopoietic allogeneic transplantation. This new trial was concentrated in patients with advanced lympho‐proliferative diseases in advanced phases and heavily pre‐treated who could not be a candidate to conventional‐intensity myeloablative preparative regimen.…”