LACE-conditioned autologous stem cell transplantation for relapsed or refractory Hodgkin's lymphoma: treatment outcome and risk factor analysis in 67 patients from a single centre

Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a recognized treatment option for patients with relapsed Hodgkin's lymphoma. We have analysed 67 patients who underwent ASCT after LACE (lomustine (CCNU), cytarabine (Ara-C), cyclophosphamide, etoposide) conditioning for relapsed (n ¼ 61) or primary refractory (n ¼ 6) Hodgkin's lymphoma. The 100-day treatment-related mortality was 3%. With a median follow-up of 67 months (range 3.3-161.0) the probabilities of overall survival (OS) and progression-free survival (PFS) at 5 years were 68 and 64%, respectively. Probabilities for OS and PFS at 5 years for patients with chemosensitive relapse (n ¼ 40) were 81 and 78% versus 50 and 35%, respectively, for patients (n ¼ 27) with chemoresistant relapse (P ¼ 0.012 for OS, P ¼ 0.002 for PFS). In multivariate analysis mixed cellularity classical or lymphocyte-depleted classical histology subtype and haemoglobin level of 10 g/dl or less at the time of ASCT were identified as risk factors for worse OS, whereas stage III or IV disease at diagnosis and disease status at ASCT other than complete or partial remission predicted inferior PFS. LACE followed by ASCT is an effective treatment for the majority of patients with chemosensitive relapsed Hodgkin's lymphoma and a proportion of chemorefractory patients also benefit.

LACE‐conditioned autologous stem cell transplantation for relapsed or refractory diffuse large B‐cell lymphoma: treatment outcome and risk factor analysis from a single centre

“…In first-line therapy for lymphoma, CRP levels on the first day of the second, third or fourth cycle of chemotherapy were found to correlate better with PFS and OS than baseline CRP values or serum LDH levels [26]. The present study is the first to show the prognostic value of CRP in the context of ASCT LACE [8] 200 1000 4000 5400 BEAC [3,7,15,22] 300 800 800 5400 BEAM [4,15] 300 400-800 800-1600 140 CBV [23] 300 1000 6000…”

“…In cases of failed peripheral blood stem cell mobilization bone marrow harvest was performed. The LACE chemotherapy regimen consisted of oral lomustine (CCNU) 200 mg/m 2 on day À7, intravenous etoposide 1000 mg/m 2 infused over 10 h on day À7, intravenous cytarabine (Ara-C) 2000 mg/m 2 infused over 12 h on days À6 and À5 and intravenous cyclophosphamide 1800 mg/m 2 infused over 1 h on days À4, À3 and À2 [8]. Autologous stem cells were infused on day 0, 48 h after the end of the last cyclophosphamide infusion.…”

Outcomes of EAM conditioned autologous haematopoietic SCT for lymphoma. A matched pairs retrospective single-centre study analysis

“…There is some suggestion that lomustine may have less pulmonary toxicity than BCNU. 5,6 Pavlu et al 5 and Perz et al 6 describe their experience with the use of LACE (lomustine, cytarabine, CY and etoposide) in the setting of relapsed or refractory HL and diffuse large B-cell lymphoma, and it appears to be well tolerated with no serious lung toxicity reported. However, this was only in the …”

Modified BEAM Conditioning Regimen in Patients with Hodgkin and Non-Hodgkin Lymphomas

“…2,3 Conversely, whenever it is used with cyclophosphamide, the association does not need a day off, allowing a shorter conditioning period.…”