Philadelphia chromosome-positive secondary acute myeloid leukemia following high-dose chemotherapy with peripheral blood progenitor cell support for relapsed low-grade non-Hodgkin's lymphoma

Stockschläder, M; Fiedler, Walter; Zander, Axel R.; Weh, Hans-Josef; Hossfeld, Dieter K.

doi:10.1007/s002770050243

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…27 Because of the heavy pretreatment with chemotherapy and radiation therapy in this patient, the occurrence of secondary AML is unlikely to be related to high-dose chemotherapy alone. 28 It can be concluded that busulfan, cyclophosphamide and etoposide (30-45 mg/kg) as the high-dose preparative regimen is well tolerated, with low extramedullary toxicity and treatment-related mortality in patients with malignant lymphoma and prior radiotherapy. This regimen is also effective, resulting in long-term disease-free survival in 50% of patients, and warrants further investigations.…”

Section: Discussionmentioning

confidence: 99%

Busulfan, cyclophosphamide and etoposide as high-dose conditioning therapy in patients with malignant lymphoma and prior dose-limiting radiation therapy

Hoffknecht

Hänel

Krüger

et al. 1998

Bone Marrow Transplant

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Summary:Relapse after transplant for malignant lymphomas remains the main cause of treatment failure. Most conditioning regimens contain total body irradiation (TBI). We investigated the toxicity and efficacy of an intensified chemotherapy conditioning regimen without TBI in patients with relapsed or high-risk malignant lymphoma who had received prior radiation therapy and were therefore not eligible for TBI. Twenty patients with a median age of 38 (18-56) and relapsed or highrisk malignant non-Hodgkin's lymphoma (NHL, n = 16) or Hodgkin's disease (HD, n = 4) underwent high-dose chemotherapy consisting of busulfan (16 mg/kg), cyclophosphamide (120 mg/kg) and etoposide 30 mg/kg (n = 8) or 45 mg/kg (n = 12) followed by peripheral stem cell support (n = 14), autologous bone marrow (n = 3), allogeneic (n = 2) or syngeneic (n = 1) transplantation. All but two had chemosensitive disease before high-dose chemotherapy. The main toxicity -according to the Bearman score -was mucositis II in 18 (90%) patients; five patients (25%) suffered a grade I hepatic toxicity. GI toxicity I occurred in three (15%) and renal toxicity I in two patients (10%). Sixty percent of the patients developed transient dermatitis with erythema and three of them (15%) had skin desquamation; one patient experienced asymptomatic pancreatitis. Toxicity was slightly higher in patients treated with 45 mg/kg etoposide. One patient (5%) died of treatment-related venoocclusive disease. After a median follow-up of 50 months (24-84) the disease-free and overall survival were 50% and 55%. One of the nine relapsing patients developed secondary AML 18 months after transplant. High-dose busulfan, cyclophosphamide and etoposide is an effective regimen resulting in long-term disease-free survival in 50% of patients with relapsed malignant lymphoma and prior radiation therapy. The toxicity is moderate with a low treatment-related mortality (5%). Keywords: malignant lymphoma; high-dose chemotherapy; etoposide; busulfan; cyclophosphamide. High-dose chemotherapy and/or radiotherapy with peripheral blood stem cell support is increasingly used in patients with high-risk or relapsed malignant non-Hodgkin's lymphoma.1-3 Recently, a randomized trial confirmed the superiority of high-dose chemotherapy followed by autologous bone marrow transplantation over standard salvage therapy for relapsing chemosensitive non-Hodgkin's lymphoma. 4 Total body irradiation (TBI) is part of many frequently used conditioning regimens. The most frequent single cause of treatment failure has been relapse. In an attempt to decrease the relapse rate, etoposide was added to the TBI/cyclophosphamide regimen because of its known activity against lymphoma. [5][6][7] However, patients with prior dose-limiting radiation therapy need alternative radiationfree preparative regimens. The combination of busulfan plus cyclophosphamide (Bu/Cy) has been widely used in patients with hematological malignancies. Initially, studies using busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg) provided an effective ...

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Section: Discussionmentioning

confidence: 99%

Busulfan, cyclophosphamide and etoposide as high-dose conditioning therapy in patients with malignant lymphoma and prior dose-limiting radiation therapy

Hoffknecht

Hänel

Krüger

et al. 1998

Bone Marrow Transplant

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“…Ph + AML is rare as a de novo diagnosis, but there are reports of Ph + t-AML following therapy for NHL, multiple myeloma, or Wegener's granulomatosis [27,28]. One patient, a 52-year-old male, developed sideroblastic anemia with 5q-and monosomy 7 after treatment with ifosphamide for non-Hodgkin lymphoma of the lung and then evolved to acute undifferentiated leukemia that expressed both the p210 and p190 bcr-abl splices [29].…”

Section: Discussionmentioning

confidence: 99%

Philadelphia chromosome-positive acute lymphoblastic leukemia secondary to chemoradiotherapy for Ewing sarcoma. Report of two cases and concise review of the literature

et al. 2004

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Survivors of childhood solid tumors including Ewing sarcoma (ES) have an increased risk of secondary malignant neoplasms (SMNs) as a consequence of exposure to chemotherapy and/or radiation (see: Bhatia S, Sklar C. Nat Rev Cancer 2002;2:124-132). The most common hematologic SMNs are myelodysplasia (MDS) and acute myelogenous leukemia (AML). Acute lymphoblastic leukemia (ALL) is uncommon in this patient population, and Philadelphia chromosome positive (Ph + ) ALL in particular, is rare. We report herein two cases of young adult patients who were both diagnosed with Ph + ALL 19 years after successful treatment for ES with combined modality therapy. A review of the relevant literature follows the case reports. Am.

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“…geringer Zahl nachzuweisen. In Nabelschnurblutproben konnte BCR-ABL bisher nicht nachgewiesen werden, daher ist davon auszugehen, dass BCR-ABL im Laufe des Lebens erworben und nicht vererbt wird(Biernaux et al 1995) Stockschläder et al (1996). gelang der Nachweis von t(9;22) bei einer t-AML nach vorausgehendem NHL.…”

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Nachweis zytogenetischer Aberrationen nach Chemotherapie zur diagnostischen Früherkennung therapieassoziierter hämatologischer Neoplasien

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Philadelphia chromosome-positive secondary acute myeloid leukemia following high-dose chemotherapy with peripheral blood progenitor cell support for relapsed low-grade non-Hodgkin's lymphoma

Cited by 7 publications

References 15 publications

Busulfan, cyclophosphamide and etoposide as high-dose conditioning therapy in patients with malignant lymphoma and prior dose-limiting radiation therapy

Busulfan, cyclophosphamide and etoposide as high-dose conditioning therapy in patients with malignant lymphoma and prior dose-limiting radiation therapy

Philadelphia chromosome-positive acute lymphoblastic leukemia secondary to chemoradiotherapy for Ewing sarcoma. Report of two cases and concise review of the literature

Nachweis zytogenetischer Aberrationen nach Chemotherapie zur diagnostischen Früherkennung therapieassoziierter hämatologischer Neoplasien

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