Survival benefit from high-dose therapy with autologous blood progenitor-cell transplantation in poor-prognosis non-Hodgkin's lymphoma.

Pettengell, Ruth; Radford, John; Morgenstern, G. R.; Scarffe, J. H.; Harris, Martin; Woll, Penella J.; Deakin, DP; Ryder, David; Wilkinson, Peter M; Crowther, Derek

doi:10.1200/jco.1996.14.2.586

Cited by 90 publications

(62 citation statements)

References 19 publications

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“…[21][22][23][24][25] This has recently been confirmed by Philip et al 9 in a randomized study showing an OS at 5 years of 53% for transplanted patients with intermediate-and high-grade lymphoma as compared to 32% in the chemotherapy group (P = 0.038). The efficacy of transplant as consolidation therapy for high-risk patients in first CR after first-line treatment has also been suggested by several groups 10, [26][27][28] and confirmed by Haioun et al 10 in a randomized trial. The present study supports the efficacy of ASCT as consolidation therapy for NHL patients with adverse prognostic factors (OS and DFS of 76 and 86%, respectively).…”

Section: Prognostic Factors In Hodgkin's Diseasementioning

confidence: 72%

“…Non Hodgkin's lymphoma patients (NHL): According to the Working Formulation, patients with NHL were classified into three groups: low-grade (LGL:A, B, C), 28 Assessment of response to transplant (definitions) patients; intermediate-and high-grade large cell (IGL:D to H), 68 patients; and lymphoblastic high-grade (HGL) (I, J), One month before transplant, complete re-staging, evaluat-16 patients. Characteristics of NHL patients at diagnosis ing previously affected areas, was performed in every are listed in Table 1: 84% were at stages III and IV, and patient.…”

Section: Transplant Proceduresmentioning

confidence: 99%

“…[33][34][35][36][37][38] The OS at 10 years with conventional chemotherapy in LGL patients with poor prognostic factors is and Sharp et al 40 have shown that infusion of contaminated products assessed by PCR or cell cultures, correlates with below 50%. 13 We have transplanted 28 LGL patients resulting in an OS of 88%, with 20 patients in CCR, DFS. 39,40 The present observation would raise concern about the importance of careful controls of products to be assessed not only by morphology but also by immunolog- …”

Section: Prognostic Factors In Hodgkin's Diseasementioning

confidence: 99%

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BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors

Caballero

Rubio

Rifón

et al. 1997

Bone Marrow Transplant

139

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Summary:with resistant disease reached CR. Incidence of OS and DFS at 3 years was 78 and 81%. DFS was similar for In the present paper, we evaluate tolerability, outcome patients transplanted with early or late relapse (95 and and prognostic factors in patients with poor prognosis 93%). With multivariate analysis, the only independent non-Hodgkin's lymphoma (NHL) and Hodgkin's disvariable for OS was CR after transplant. In conclusion, ease (HD) when uniformly treated with BCNU, etopothe present results demonstrate the efficacy and low toxside, cytarabine and melphalan (BEAM) and autologous icity of the BEAM regimen in high-risk lymphoma stem cell transplant (ASCT). One hundred and fortypatients with sensitive disease. Other strategies should eight patients with NHL (n = 112) or HD (n = 36) be investigated for patients with refractory lymphoma. received BEAM followed by infusion of bone marrow Keywords: non-Hodgkin's lymphoma; Hodgkin's dis- well as in those with Hodgkin's disease, a high rate of compatients were transplanted in 1st CR due to the presence plete remission (CR) and long-term survival are achieved of у2 adverse prognostic features at diagnosis or to a with conventional chemotherapy. 1-5 However, the progslow CR. Of the HD patients at transplant 17 had active nosis is poor for those who fail to achieve CR or who disease, 16 were in у2 CR and three in 1st CR. The relapse after chemotherapy. Response to standard salvage overall percentage of toxic deaths was 5.4%, while in therapy in these latter patients ranges between 20 and 60% the group of patients transplanted with PBSC it was and durable remissions are rarely observed. 6,7 Moreover, in only 1.3%. NHL patients: 78% were in CR following NHL patients with two or more adverse prognostic factors ASCT, including 25 out of 45 patients (56%) who were according to the international index, conventional treatment transplanted with active disease. Only two of the 11 offers very poor results (37 and 21% disease-free survival patients transplanted with resistant disease achieved after 5 years). 8 Two recent reports have shown the benefits CR. Incidence of overall survival (OS) and disease-free of bone marrow transplantation (BMT) compared to survival (DFS) at 3 years was 65 and 75%, respectively. chemotherapy both in patients in first relapse 9 and in those As far as histology was concerned, OS was significantly in first CR with poor prognostic factors. 10 In spite of probetter for patients with LGL in comparison with IGL longed initial reponse and long survival, indolent lym-(88 vs 56%) (P = 0.002). DFS was significantly higher phomas are ultimately as lethal as other NHL and confor patients transplanted in first CR or first partial sidered incurable with conventional chemotherapy. 11 Some remission (PR) than it was for those transplanted in a recent reports 12,13 have validated the international prognoslater CR or PR (86 vs 53%) (P = 0.02). Multivariate tic index (IPI) for patients with follicular lymphoma and analysis for OS showed that histology, bulky di...

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Section: Prognostic Factors In Hodgkin's Diseasementioning

confidence: 72%

Section: Transplant Proceduresmentioning

confidence: 99%

Section: Prognostic Factors In Hodgkin's Diseasementioning

confidence: 99%

See 1 more Smart Citation

BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors

Caballero

Rubio

Rifón

et al. 1997

Bone Marrow Transplant

139

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show abstract

“…The curves tend to a plateau after 24 months (only one event after this time) confirming that no deaths or relapses are expected after that time-point for these patients, as already published by others. 20 Transplant does not apparently change the quality of response in the group of refractory/resistant and relapsed patients and 13 of the 16 reported deaths happened in this group.…”

Section: Discussionmentioning

confidence: 99%

Autologous stem cell transplantation for T and null cell CD30-positive anaplastic large cell lymphoma: analysis of 64 adult and paediatric cases reported to the European Group for Blood and Marrow Transplantation (EBMT)

Fanin

Elvira

Sperotto

et al. 1999

Bone Marrow Transplant

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Summary:Anaplastic large cell lymphoma (ALCL) is a heterogeneous family of lymphoid tumours, among which the T and null cell types were recently listed in the REAL classification as a distinct entity. Reports on autologous stem cell transplantation (ASCT) in this group are only occasional. Sixty-four patients with T and null cell ALCL from 25 European centres had been registered with the European Group for Blood and Marrow Transplantation (EBMT) at the onset of this study. The median age was 25 years (range 3.2-53.0). Thirty of the 64 patients (47%) were in complete remission (CR), 18 (28%) in partial remission (PR), and the remaining 16 (25%) had a more advanced or chemotherapy-refractory disease at transplant. Eighty-one percent of the patients were conditioned with chemotherapy alone and 75% received marrow stem cells. All the patients transplanted in first CR (15), except one, maintained the CR over time; six of 15 transplanted in CR subsequent to first, six of 18 transplanted in PR and 14 of 16 transplanted in refractory or relapsed disease progressed. Actuarial overall survival (OS) at 10 years is 70%. Multivariate analysis showed that good status at transplant, younger age, absence of B symptoms and absence of extranodal disease indicated a better prognosis. These data suggest that ASCT should be considered as a possible treatment for chemosensitive patients in CR or PR. However, definitive conclusions cannot be drawn from this study and a prospective randomised trial between ASCT and conventional chemotherapy may be indicated. Keywords: anaplastic large cell lymphoma; autologous stem cell transplantationThe therapy of primary systemic CD30-positive anaplastic large cell lymphoma (ALCL) with third generation regimens of chemotherapy (CHT) is successful in about 70%Correspondence: Dr R Fanin, Division of Hematology, University Hospital, Ple S Maria della Misericordia, 33100 Udine, Italy Received and accepted 5 October 1998 of the cases, with some recent series showing up to 90% of complete remissions. 1-8 Relapse rate ranges widely from 25 to 45%, with less than 50% of patients alive and free of disease at a median observation time from diagnosis no longer than 36 months. [1][2][3][4][5][6][7][8] The different behaviour in relapse rate may reflect the existence of a heterogeneous family of diseases: ALCL T and null cell common type, ALCL T and null cell Hodgkin-like and diffuse anaplastic large B cell lymphoma. 9,10 These three major entities probably have different prognosis and outcome, but this is not clearly underlined in the papers already published on this subject. 11,12 It is surprising that although the clinical, histological and immunophenotypic characteristics indicate that this lymphoma may be a group of aggressive lymphoid tumours, reports on autologous stem cell transplantation (ASCT) in ALCL are occasional, and mainly refer to cases in relapse. 1,2,4,5 It was recently shown, in a study performed on a small monocentric series, that primary systemic CD30-positive ALCL of the adults is a curable...

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“…Recently, myeloablative chemotherapy followed by PBSCThas been the method of choice to achieve long-term survival (5). The role of PBSCTas a second-line treatment in aggressive NHLin adult patients is debatable (6,7). Weshowed the feasibility of PBSCTfor patients aged 65 years and older in PR cases.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Blood Stem Cell Transplantation in Patients Over 65 Years Old with Malignant Lymphoma-Possibility of Early Completion of Chemotherapy and Improvement of Performance Status-

2001

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Objective After the initial clinical application of peripheral blood stem cell transplantation (PBSCT) in the latter half of the 1980s, the frequency of PBSCTfor nonHodgkin's lymphoma (NHL) has been gradually increasing. At present, PBSCTis an important procedure for treating young patients with NHL.This procedure is now being increasingly used as a part of the chemotherapy regimen for elderly patients. Conclusion Despite the small number of cases, this procedure is beneficial for completing chemotherapy earlier and promoting a good quality of life. (Internal Medicine 40: 471-474, 2001)

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Survival benefit from high-dose therapy with autologous blood progenitor-cell transplantation in poor-prognosis non-Hodgkin's lymphoma.

Abstract: Patients with poor prognostic features who received high-dose therapy and BPC rescue had a superior EFS. The survival differences observed in this study justify a formal comparison in a randomized study.

Cited by 90 publications

References 19 publications

BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors

BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors

Autologous stem cell transplantation for T and null cell CD30-positive anaplastic large cell lymphoma: analysis of 64 adult and paediatric cases reported to the European Group for Blood and Marrow Transplantation (EBMT)

Peripheral Blood Stem Cell Transplantation in Patients Over 65 Years Old with Malignant Lymphoma-Possibility of Early Completion of Chemotherapy and Improvement of Performance Status-

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