The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of diffuse large cell B-cell non-Hodgkin's lymphoma: An evidence-based review

Hahn, Theresa; Wolff, Steven N.; Czuczman, Myron S.; Fisher, Richard I.; Lazarus, Hillard M.; Vose, Julie M.; Warren, Lisa; Watt, Richard; McCartby, Philip L.

doi:10.1016/s1083-8791(01)80003-3

Cited by 52 publications

(19 citation statements)

References 58 publications

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“…[1][2][3] Among patients with chemosensitive disease, the remission status at transplant has a significant impact on the outcome, because patients in complete remission before high-dose therapy achieve better longterm progression-free survival than patients who undergo transplantation in partial remission. 4,5 Standard salvage chemotherapy for aggressive lymphoma does not exist.…”

Section: Introductionmentioning

confidence: 99%

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study

Martı́n¹,

Conde²,

Arnán³

et al. 2008

Haematologica

158

118

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Section: Introductionmentioning

confidence: 99%

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study

Martı́n¹,

Conde²,

Arnán³

et al. 2008

Haematologica

158

118

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“…Examples include expert panels from the National Cancer Center Network (NCCN), American Society of Blood and Marrow Transplantation (ASBMT). [60][61][62][63][64][65] These panels performed structured evidence-based reviews and made consensus recommendations of graded strength. 20 Mechanisms of panel selection and process for quantifying consensus were not specified.…”

Section: Expert Opinion In Transplantsmentioning

confidence: 99%

Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants?

Gale

Eapen

Logan

et al. 2009

Bone Marrow Transplant

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Approaches to determine whether one transplant-related therapy is better than another include: (1) using experimental data, such as those from randomized controlled trials (RCTs); (2) using observational data, such as those from observational databases (ODBs) and (3) using conclusions from the structured quantification of expert opinion based on a consideration of evidence from RCTs, ODBs and other sources. Large RCTs are widely and appropriately regarded as the gold standard of clinical investigation. However, data from large RCTs are rarely available for transplant-related therapy questions. We discuss some of the limitations of RCTs in the transplant setting often including small size and short follow-up. These limitations are only partly solved by meta-analyses of RCTs. Data from high-quality ODBs are not only often useful in this setting but also have limitations. Biases may be difficult or impossible to identify and/or adjust for. However, ODBs have large numbers of diverse subjects receiving diverse therapies and analyses that often give answers more useful to clinicians than RCTs. Side-by-side comparisons suggest analyses from high-quality ODBs often give similar conclusions to meta-analyses of highquality RCTs. Meta-analyses combining data from RCTs and ODBs are sometimes appropriate. Quantitation of expert opinion, when of high quality, is also useful: experts rarely disagree under precisely defined circumstances and their consensus conclusions are often concordant with results of high-quality RCTs and ODBs. We suggest increased use of ODBs and expert opinion as reliable and effective ways to determine relative efficacies of new therapies in transplant settings.

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“…For non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) patients who are not treated successfully with conventional therapy, high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) has proven curative in a substantial number of cases, and is the standard of care in some situations. 1 That said, many of the elements of HDC þ AHSCT are not standardized; [1][2][3][4][5] specifically, no one HDC regimen has been proven optimal. [1][2][3][4][5][6][7][8] Nonetheless, carmustine (BCNU), etoposide (VP16-213), cytarabine (Ara-C) and melphalan (MEL) -the so-called BEAM regimen 9 -is widely utilized, and had no obvious superior in recent large but nonrandomized analyses.…”

mentioning

confidence: 99%

“…1 That said, many of the elements of HDC þ AHSCT are not standardized; [1][2][3][4][5] specifically, no one HDC regimen has been proven optimal. [1][2][3][4][5][6][7][8] Nonetheless, carmustine (BCNU), etoposide (VP16-213), cytarabine (Ara-C) and melphalan (MEL) -the so-called BEAM regimen 9 -is widely utilized, and had no obvious superior in recent large but nonrandomized analyses. 7,8 However, and admittedly minimizing the uncertain role of cotransplantation of clonogenic lymphoma cells, 10,11 BEAM permits a substantial number of relapses, and increasing the activity of BEAM (or other regimens) without excessive toxicity could be very useful.…”

mentioning

confidence: 99%

Activity of single-agent melphalan 220–300 mg/m2 with amifostine cytoprotection and autologous hematopoietic stem cell support in non-Hodgkin and Hodgkin lymphoma

Phillips

Meisenberg

Reece

et al. 2004

Bone Marrow Transplant

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Summary:High-dose chemotherapy using melphalan (HDMEL) is an important component of many conditioning regimens that are given before autologous hematopoietic stem cell transplantation (AHSCT). In contrast to the situation in myeloma, and to a lesser degree acute leukemia, only a very limited published experience exists with the use of HDMEL conditioning as a single agent in doses requiring AHSCT for lymphoma, both Hodgkin lymphoma (HL) and especially non-Hodgkin lymphoma (NHL). Thus, we report results of treating 26 lymphoma patients (22 with NHL and four with HL) with HDMEL 220-300 mg/m 2 plus amifostine (AF) cytoprotection and AHSCT as part of a phase I-II trial. Median age was 51 years (range 24-62 years); NHL histology was varied, but was aggressive (including transformed from indolent) in 19 patients, indolent in two patients and mantle cell in one. All 26 patients had been extensively treated; 11 were refractory to the immediate prior therapy on protocol entry and two had undergone prior AHSCT. All were deemed ineligible for other, 'first-line' AHSCT regimens. Of these 26 patients, 22 survived to initial tumor evaluation on D þ 100. At this time, 13 were in complete remission, including four patients who were in second CR before HDMEL þ AF þ AHSCT. Responses occurred at all HDMEL doses. Currently, seven patients are alive, including five without progression, with a median followup in these latter patients of D þ 1163 (range D þ 824 to D þ 1630); one of these patients had a nonmyeloablative allograft as consolidation on D þ 106. Conversely, 14 patients relapsed or progressed, including five who had previously achieved CR with the AHSCT procedure.Two patients, both with HL, remain alive after progression; one is in CR following salvage radiotherapy. Six patients died due to nonrelapse causes, including two NHL patients who died while in CR. We conclude that HDMEL þ AF þ AHSCT has significant single-agent activity in relapsed or refractory NHL and HL. This experience may be used as a starting point for subsequent dose escalation of HDMEL (probably with AF) in established combination regimens. For non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) patients who are not treated successfully with conventional therapy, high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) has proven curative in a substantial number of cases, and is the standard of care in some situations. 1 That said, many of the elements of HDC þ AHSCT are not standardized; 1-5 specifically, no one HDC regimen has been proven optimal. 1-8 Nonetheless, carmustine (BCNU), etoposide (VP16-213), cytarabine (Ara-C) and melphalan (MEL) -the so-called BEAM regimen 9 -is widely utilized, and had no obvious superior in recent large but nonrandomized analyses. 7,8 However, and admittedly minimizing the uncertain role of cotransplantation of clonogenic lymphoma cells, 10,11 BEAM permits a substantial number of relapses, and increasing the activity of BEAM (or other regimens) without excessive toxicity could be very us...

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The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of diffuse large cell B-cell non-Hodgkin's lymphoma: An evidence-based review

Cited by 52 publications

References 58 publications

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study

Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants?

Activity of single-agent melphalan 220–300 mg/m2 with amifostine cytoprotection and autologous hematopoietic stem cell support in non-Hodgkin and Hodgkin lymphoma

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