Single-agent high-dose melphalan followed by auto-SCT for relapsed and refractory Hodgkin lymphoma in children and adolescents

Guilcher, Gregory M.T.; F, Rizzuti; Lewis, Victor; Stewart, D. A.

doi:10.1038/bmt.2011.97

Cited by 4 publications

(5 citation statements)

References 23 publications

(58 reference statements)

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“…In human oncology, the melphalan‐containing BEAM (carmustine, etoposide, cytosine arabinoside and melphalan) protocol is a commonly used bone marrow conditioning regimen prior to stem cell transplant in patients with HL or NHL, with melphalan typically given at a dosage of 140 mg m −2 . However, when used as a single‐agent for the same purpose the melphalan dosage can be increased by 42% to 71% . Potential dose escalation is further supported by the fact that the majority of dogs in this study experienced low grade or no AEs from treatment with only 1 dog experiencing a grade 4 AE (neutropenia).…”

Section: Discussionsupporting

confidence: 46%

“…A phase I study of intravenous melphalan did include 2 dogs with lymphoma but no response or outcome data was included due to the nature of that study . Single‐agent high‐dose melphalan has been shown to have activity in relapsed Hodgkin lymphoma (HL) and non‐Hodgkin lymphoma (NHL) in people and, thus, may also be active in the canine counterpart. Therefore, the purpose of this retrospective study was to evaluate the efficacy and adverse event (AE) profile of oral melphalan for the treatment of relapsed canine lymphoma.…”

Section: Introductionmentioning

confidence: 99%

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Oral melphalan for the treatment of relapsed canine lymphoma

Mastromauro

Suter

Hauck

et al. 2017

Vet Comparative Oncology

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Oral melphalan has been included in multi-agent rescue protocols for canine lymphoma but its activity as a single-agent for this purpose has not been established. Inexpensive cost, ease of administration and tolerability make oral melphalan an attractive candidate for single-agent rescue therapy of canine lymphoma. Retrospective evaluation of 19 cases of relapsed canine lymphoma treated with oral melphalan was performed. Melphalan was primarily administered (n = 16) via a high dose protocol (HDM) with a median dosage of 19.4 mg m . Fifteen dogs (78.9%) were treated concurrently with corticosteroids. Response evaluation was possible for all dogs with a calculated overall clinical benefit (partial response [PR] + stable disease [SD]) of 31.6% (PR 3/19; SD 3/19). Times to progression following melphalan (TTP-M) were 14, 24 and 34 days for responders and 20, 28 and 103 days for dogs experiencing SD. Twelve of 17 dogs evaluable for toxicity experienced an adverse event (AE) with only 3 dogs experiencing a grade III or higher AE. Haematologic toxicity was common (11/17) while gastrointestinal toxicity was rare (1/17). Although treatment resulted in limited clinical benefit and non-durable responses, oral melphalan was well-tolerated and may be a reasonable rescue option in cases where minimal effective agents remain.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Oral melphalan for the treatment of relapsed canine lymphoma

Mastromauro

Suter

Hauck

et al. 2017

Vet Comparative Oncology

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“…44 Single-agent, high-dose melphalan has also been used with success. 45,46 The EFS and OS rates in these publications are comparable to other published reports, and a randomized trial, if feasible, would best answer a question regarding superiority of a given combination of conditioning agents.…”

supporting

confidence: 66%

Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant

Guilcher¹,

Stewart²

2014

COAYA

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Hodgkin lymphoma is one of the most common cancers of adolescence and young adulthood. Most patients are cured of their disease, with very high cure rates in early stage disease and improving rates of cure even in those who present with advanced stage disease. Upfront therapy often involves chemotherapy and radiation therapy; with improving cure rates, acute and late effects of therapy are informing newer treatment protocols to avoid toxicities. Those children and adolescents with refractory or relapsed disease have lower rates of cure and generally warrant more intensive therapy. High-dose chemotherapy and autologous stem cell transplantation is often administered in such cases. This intensive intervention can be curative, but carries additional risks in the short and long term. This review includes a discussion of both transplant and non-transplant therapy for relapsed disease, commonly employed conditioning regimens, acute and late toxicities of therapy, as well as quality of life data. In addition, newer approaches to therapy for Hodgkin lymphoma are reviewed, with a focus on how such novel therapies might relate to high-dose chemotherapeutic approaches.

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“…The contribution of HDT to the OS outcome in our study is not clear. While published literature on the efficacy of HDT and SCT in recurrent or refractory HL in children is promising (Lieskovsky et al , ; Schellong et al , ; Daw et al , ; Guilcher et al , ), it is unclear whether this approach is justified in all patients with recurrent HL. Although 55% [ n = 43] of the patients proceeded to receive HDT followed by stem cell rescue, the treatment that they received prior to HDT was not uniform.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcome in children and adolescents with relapsed Hodgkin lymphoma - results of the UK HD3 relapse treatment strategy

et al. 2014

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SummaryThe purpose of this national retrospective study was to evaluate the outcome in children with relapsed or primary refractory Hodgkin lymphoma Other poor prognostic factors included advanced stage disease at relapse and B symptoms at first diagnosis. The most important factor associated with salvage failure was time to relapse. Survival outcome in children with primary refractory HL is poor.

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Single-agent high-dose melphalan followed by auto-SCT for relapsed and refractory Hodgkin lymphoma in children and adolescents

Cited by 4 publications

References 23 publications

Oral melphalan for the treatment of relapsed canine lymphoma

Oral melphalan for the treatment of relapsed canine lymphoma

Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant

Treatment outcome in children and adolescents with relapsed Hodgkin lymphoma - results of the UK HD3 relapse treatment strategy

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