Mitoxantrone-melphalan conditioning regimen for autologous stem cell transplantation in relapsed/refractory lymphoma

Mitoxantrone-melphalan conditioning regimen for autologous stem cell transplantation in relapsed/refractory lymphoma

Background/aim: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become thestandard approach for patients with relapsed/refractory Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL).In this study, we report the outcome of the mitoxantrone-melphalan conditioning regimen for lymphoma.Materials and methods: The study group included 53 patients who were relapsed/refractory HL (n = 14) and NHL (n =39) and received mitoxantrone and melphalan followed by ASCT. The transplant regimen consisted of mitoxantrone (60mg/m2) and melphalan (180 mg/m2) followed by peripheral blood stem cell infusion (PBSC).Results: Prior to high-dose chemotherapy, 37.7% of the patients were in complete remission (CR) and 45.3% were inpartial remission (PR), and 17% had stable or progressive disease. After high-dose chemotherapy and PBSC, 44 out of 51patients achieved CR (86.2%). CR was achieved in 24 out of 33 patients (72.7%) who were transplanted in a marginallyactive phase of the disease. At a median followup of 25.4 months (1.8–131.3 months) after ASCT, 13 patients relapsed/progressed and 8 patients died. The estimated 2-year overall survival (OS) was 81.9%, and event-free survival (EFS) was59.3%.Conclusion: High-dose chemotherapy followed by ASCT is an effective conditioning regimen in relapsed/refractorylymphoma patients who are undergoing ASCT.

___

  • 1. Linch D, Goldstone A, McMillan A, Chopra R, Hudson GV et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. The Lancet 1993; 341 (8852): 1051-1054.
  • 2. Stiff PJ, Unger JM, Cook JR, Constine LS, Couban S et al. Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma. New England Journal of Medicine 2013; 369 (18): 1681-1690. doi: 10.1056/NEJMoa1301077
  • 3. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. New England Journal of Medicine 1995; 333 (23): 1540-1545. doi: 10.1056/nejm199512073332305
  • 4. Mills W, Chopra R, McMillan A, Pearce R, Linch D et al. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin’s lymphoma. Journal of Clinical Oncology 1995; 13 (3): 588-595.
  • 5. Chen Y-B, Lane AA, Logan BR, Zhu X, Akpek G et al. Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Biology of Blood and Marrow Transplantation 2015; 21 (6): 1046-1053.
  • 6. Isidori A, Piccaluga PP, Loscocco F, Guiducci B, Barulli S et al. High-dose therapy followed by stem cell transplantation in Hodgkin’s lymphoma: past and future. Expert Review of Hematology. 2013; 6 (4): 451-464. doi: 10.1586/17474086.2013.814451
  • 7. Salar A, Sierra J, Gandarillas M, Caballero MD, Marin J et al. Autologous stem cell transplantation for clinically aggressive non-Hodgkin’s lymphoma: the role of preparative regimens. Bone Marrow Transplantation 2001; 27 (4): 405-412. doi: 10.1038/sj.bmt.1702795
  • 8. Puig N, De La Rubia J, Remigia MJ, Jarque I, Martín G et al. Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation. Leukemia & Lymphoma 2006; 47 (8): 1488-1494.
  • 9. Ciurea SO, Andersson BS. Busulfan in hematopoietic stem cell transplantation. Biology of Blood and Marrow Transplantation 2009; 15 (5): 523-536.
  • 10. Ulrickson M, Aldridge J, Kim HT, Hochberg EP, Hammerman P et al. Busulfan and cyclophosphamide (Bu/Cy) as a preparative regimen for autologous stem cell transplantation in patients with non-Hodgkin lymphoma: a single-institution experience. Biology of Blood and Marrow Transplantation 2009; 15 (11): 1447-1454.
  • 11. Stockerl-Goldstein K, Horning S, Negrin R, Chao N, Hu W et al. Influence of preparatory regimen and source of hematopoietic cells on outcome of autotransplantation for non-Hodgkin’s lymphoma. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation 1996; 2 (2): 76-85.
  • 12. Villa D, Crump M, Keating A, Panzarella T, Feng B et al. Outcome of patients with transformed indolent non-Hodgkin lymphoma referred for autologous stem-cell transplantation. Annals of Oncology 2013; 24 (6): 1603-1609. doi: 10.1093/ annonc/mdt029
  • 13. Berber I, Erkurt MA, Nizam I, Koroglu M, Kaya E et al. Can BuCyE conditioning regimen be an alternative treatment to BEAM at autologous transplantation in malignant lymphoma patients? A single center experience. International Journal of Clinical and Experimental Medicine 2015; 8 (9): 16308-16314.
  • 14. Musso M, Messina G, Di Renzo N, Di Carlo P, Vitolo U et al. Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen. British Journal of Haematology 2016; 172 (1): 111-121. doi: 10.1111/bjh.13803
  • 15. Garciaz S, Coso D, Schiano de Collela JM, Broussais F, Stoppa AM et al. Bendamustine-based conditioning for non-Hodgkin lymphoma autologous transplantation: an increasing risk of renal toxicity. Bone Marrow Transplantation 2016; 51 (2): 319- 321. doi: 10.1038/bmt.2015.257
  • 16. Kim JW, Lee HJ, Yi HG, Kim BS, Bang SM et al. Mitoxantrone, etoposide, cytarabine, and melphalan (NEAM) followed by autologous stem cell transplantation for patients with chemosensitive aggressive non-Hodgkin lymphoma. American Journal of Hematology 2012; 87 (5): 479-483. doi: 10.1002/ ajh.23150
  • 17. Sellner L, Boumendil A, Finel H, Choquet S, de Rosa G et al. Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT. Bone Marrow Transplantation 2016; 51 (2): 212-218. doi: 10.1038/bmt.2015.273
  • 18. Isidori A, Christofides A, Visani G. Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning. Leukemia & Lymphoma 2016; 57 (11): 2499-2509. doi: 10.1080/10428194.2016.1185785
  • 19. Oyan B, Koc Y, Ozdemir E, Kars A, Turker A et al. High dose sequential chemotherapy and autologous stem cell transplantation in patients with relapsed/refractory lymphoma. Leukemia & Lymphoma 2006; 47 (8): 1545-1552.
  • 20. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L et al. Revised response criteria for malignant lymphoma. Journal of Clinical Oncology. 2007; 25 (5): 579-586.
  • 21. Pasquini M, Wang Z, Horowitz M, Gale R. 2010 report from the Center for International Blood and Marrow Transplant Research (CIBMTR): current uses and outcomes of hematopoietic cell transplants for blood and bone marrow disorders. Clinical Transplants 2010: 87-105.
  • 22. Bains T, Chen AI, Lemieux A, Hayes-Lattin BM, Leis JF et al. Improved outcome with busulfan, melphalan and thiotepa conditioning in autologous hematopoietic stem cell transplant for relapsed/refractory Hodgkin lymphoma. Leukemia & Lymphoma 2014; 55 (3): 583-587.
  • 23. Moskowitz AJ, Moskowitz CH. Controversies in the treatment of lymphoma with autologous transplantation. The Oncologist 2009; 14 (9): 921-929.
  • 24. Nademanee A. Transplantation for non-Hodgkin lymphoma. Expert Review of Hematology 2009; 2 (4): 425-442.
  • 25. Cortelazzo S, Rambaldi A, Rossi A, Oldani E, Ghielmini M et al. Intensification of salvage treatment with high‐dose sequential chemotherapy improves the outcome of patients with refractory or relapsed aggressive non‐Hodgkin’s lymphoma. British Journal of Haematology 2001; 114 (2): 333-341.
  • 26. Rancea M, von Tresckow B, Monsef I, Engert A, Skoetz N. High-dose chemotherapy followed by autologous stem cell transplantation for patients with relapsed or refractory Hodgkin lymphoma: a systematic review with meta-analysis. Critical Reviews in Oncology/Hematology 2014; 92 (1): 1-10.
  • 27. Mink SA, Armitage JO. High-dose therapy in lymphomas: a review of the current status of allogeneic and autologous stem cell transplantation in Hodgkin’s disease and non-Hodgkin’s lymphoma. The Oncologist 2001; 6 (3): 247-256.
  • 28. Vose JM, Zhang M-J, Rowlings PA, Lazarus HM, Bolwell BJ et al. Autologous transplantation for diffuse aggressive nonHodgkin’s lymphoma in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. Journal of Clinical Oncology 2001; 19 (2): 406-413.
  • 29. Robinson SP, Boumendil A, Finel H, Blaise D, Poire X et al. Autologous stem cell transplantation for relapsed/ refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party. Bone Marrow Transplantation 2016; 51 (3): 365-371. doi: 10.1038/ bmt.2015.286
  • 30. Gupta A, Gokarn A, Rajamanickam D, Punatar S, Thippeswamy R et al. Lomustine, cytarabine, cyclophosphamide, etoposide - An effective conditioning regimen in autologous hematopoietic stem cell transplant for primary refractory or relapsed lymphoma: Analysis of toxicity, long-term outcome, and prognostic factors. Journal of Cancer Research and Therapeutics 2018; 14 (5): 926-933. doi: 10.4103/0973- 1482.181183
  • 31. Garciaz S, Coso D, Schiano de Collela JM, Broussais F, Stoppa AM et al. Bendamustine-based conditioning for non-Hodgkin lymphoma autologous transplantation: an increasing risk of renal toxicity. Bone Marrow Transplantation 2015; 51: 319. doi: 10.1038/bmt.2015.257
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: 6
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Risk factors for coronary artery disease in young patients with stable angina pectoris

Mustafa DURAN, İbrahim Etem ÇELİK, Sani MURAT, Deniz ELÇİK, Fatih ÖKSÜZ

Association between PPARGC1A single nucleotide polymorphisms and increased risk of nonalcoholic fatty liver disease among Iranian patients with type 2 diabetes mellitus

Zahra HOSSEINI-KHAH, Zohreh SALTANATPOUR, Hassan HOSSEINZADEH, Shirin LOTFIPANAH, Masumeh MOHAMMADI, Behrooz JOHARI, Leila SAREMI

Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial

Aslı KARAKUŞ ÇALIŞKAN, Ayşe BORA TOKÇAER, Özden ÖZYEMİŞCİ TAŞKIRAN, Tuğba ATAN, Gülçin KAYMAK KARATAŞ, Belgin KARAOĞLAN

Childhood atopic dermatitis: current developments, treatment approaches, and future expectations

Ümit Murat ŞAHİNER, Pınar GÜR ÇETİNKAYA

Türkan TÜZÜN, Selda Sayin KUTLU, Murat KUTLU, İlknur KALELİ

Prognostic importance of PTEN, EGFR, HER-2, and IGF-1R in gastric cancer patients treated with postoperative chemoradiation

Gül KANYILMAZ, Meryem AKTAN, Mehmet KOÇ, Sümeyye KOZACIOĞLU, Berrin BENLİ YAVUZ

Mustafa DURAN, Deniz ELÇİK, Sani Namik MURAT, Fatih ÖKSÜZ, İbrahim Etem ÇELİK

Hasanali DURMAZ

Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters

Burak KATİPOĞLU, Togay EVRİN, Banu SÜZEN, Nalan OGAN, Evrim Eylem AKPINAR, Gökçe Kaan ATAÇ, Ayşe BAHA, Yusuf AYDEMİR

Hasanali DURMAZ, Erdem BİRGİ