Outcomes of Patients with Recurrent and Refractory Lymphoma Undergoing Allogeneic Hematopoietic Cell Transplantation with BEAM Conditioning and Sirolimus- and Tacrolimus-Based GVHD Prophylaxis.
Adolescent
Adult
Allografts
Antineoplastic Combined Chemotherapy Protocols
/ administration & dosage
Carmustine
/ administration & dosage
Cytarabine
/ administration & dosage
Disease-Free Survival
Female
Graft vs Host Disease
/ mortality
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Lymphoma
/ mortality
Male
Melphalan
/ administration & dosage
Middle Aged
Podophyllotoxin
/ administration & dosage
Sirolimus
/ administration & dosage
Survival Rate
Tacrolimus
/ administration & dosage
Transplantation Conditioning
BEAM conditioning
allogeneic hematopoietic stem cell transplantation
tacrolimus/sirolimus
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
Titre abrégé: Biol Blood Marrow Transplant
Pays: United States
ID NLM: 9600628
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
11
07
2018
accepted:
07
09
2018
pubmed:
19
9
2018
medline:
25
12
2019
entrez:
19
9
2018
Statut:
ppublish
Résumé
The current standard of care for patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is high-dose conditioning followed by autologous stem cell transplantation (ASCT). For some patients (ie, those with highest-risk disease, insufficient stem cell numbers after mobilization, or bone marrow involvement) allogeneic hematopoietic cell transplantation (alloHCT) offers the potential for cure. However, the majority of patients undergoing alloHCT receive reduced-intensity conditioning as a preparative regimen, and studies assessing outcomes of patients after alloHCT with myeloablative conditioning are limited. In this retrospective study, we reviewed outcomes of 22 patients with recurrent and refractory NHL who underwent alloHCT with myeloablative BEAM conditioning and received tacrolimus/sirolimus as graft-versus-host disease (GVHD) prophylaxis at City of Hope between 2005 and 2018. With a median follow-up of 2.6 years (range, 1.0 to 11.2 years), the probabilities of 2-year overall survival and event-free survival were 58.3% (95% confidence interval [CI], 35.0% to 75.8%) and 45.5% (95% CI, 24.4% to 64.3%), respectively. The cumulative incidence of grade II to IV acute GVHD was 45.5% (95% CI, 23.8% to 64.9%), with only 1 patient developing grade IV acute GVHD. However, chronic GVHD was seen in 55% of the patients (n = 12). Of the 22 eligible patients, 2 had undergone previous ASCT and 2 had undergone previous alloHCT. Both patients with previous ASCT developed severe regimen-related toxicity. Patients who underwent alloHCT with chemorefractory disease had lower survival rates, with 1-year OS and EFS of 44.4% and 33.0%, respectively. In conclusion, alloHCT with a BEAM preparative regimen and tacrolimus/sirolimus-based GVHD should be considered as an alternative option for patients with highest-risk lymphoma whose outcomes are expectedly poor after ASCT.
Identifiants
pubmed: 30227232
pii: S1083-8791(18)30566-4
doi: 10.1016/j.bbmt.2018.09.009
pmc: PMC6502508
mid: NIHMS1516268
pii:
doi:
Substances chimiques
Cytarabine
04079A1RDZ
Podophyllotoxin
L36H50F353
Melphalan
Q41OR9510P
Carmustine
U68WG3173Y
Sirolimus
W36ZG6FT64
Tacrolimus
WM0HAQ4WNM
Types de publication
Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
287-292Subventions
Organisme : NHLBI NIH HHS
ID : U10 HL069278
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG1 HL069278
Pays : United States
Informations de copyright
Copyright © 2018. Published by Elsevier Inc.
Références
Blood. 2017 Oct 19;130(16):1800-1808
pubmed: 28774879
Blood. 2016 Feb 18;127(7):938-47
pubmed: 26670632
J Clin Oncol. 2018 May 10;36(14):1428-1439
pubmed: 29584546
Br J Haematol. 2016 Apr;173(1):96-104
pubmed: 26729448
Blood. 2010 Feb 4;115(5):1098-105
pubmed: 19965688
Biol Blood Marrow Transplant. 2006 Jul;12(7):703-11
pubmed: 16785059
Ann Hematol. 2015 Nov;94(11):1839-43
pubmed: 26246466
Blood. 2014 Aug 21;124(8):1372-7
pubmed: 24982504
J Clin Oncol. 2017 Jan;35(1):24-31
pubmed: 28034071
Cancer Chemother Pharmacol. 2002 May;49 Suppl 1:S13-20
pubmed: 12042984
Biol Blood Marrow Transplant. 2016 Mar;22(3):493-8
pubmed: 26497906
Br J Haematol. 2008 Nov;143(3):395-403
pubmed: 18759762
Biol Blood Marrow Transplant. 2010 Jan;16(1):35-45
pubmed: 20053330
J Clin Oncol. 2008 Dec 10;26(35):5767-74
pubmed: 19001324
Blood. 2004 Jan 15;103(2):428-34
pubmed: 12969983
Ann Oncol. 1999 May;10(5):527-32
pubmed: 10416001
Biol Blood Marrow Transplant. 2013 May;19(5):746-53
pubmed: 23380340
Blood. 2006 Jul 1;108(1):382-9
pubmed: 16522821
Biol Blood Marrow Transplant. 2015 Jun;21(6):1046-1053
pubmed: 25687795
J Clin Oncol. 2009 Jan 20;27(3):426-32
pubmed: 19064981
Bone Marrow Transplant. 2013 Feb;48(2):278-83
pubmed: 23000644
Blood. 2007 Apr 1;109(7):3108-14
pubmed: 17138818
J Clin Oncol. 2010 Sep 20;28(27):4184-90
pubmed: 20660832
J Clin Oncol. 2017 Jul 1;35(19):2125-2132
pubmed: 28441111
N Engl J Med. 1995 Dec 7;333(23):1540-5
pubmed: 7477169
Haematologica. 2012 Jul;97(7):1085-91
pubmed: 22315486
Leuk Res. 2012 Sep;36(9):1152-6
pubmed: 22677229
Biol Blood Marrow Transplant. 2015 Mar;21(3):483-8
pubmed: 25490180
Leukemia. 2011 Feb;25(2):341-7
pubmed: 21135857
Biol Blood Marrow Transplant. 2016 Sep;22(9):1543-1551
pubmed: 27131863
Haematologica. 2012 Dec;97(12):1882-9
pubmed: 22689677
Blood. 2003 Sep 1;102(5):1601-5
pubmed: 12730113
Biol Blood Marrow Transplant. 2010 Jan;16(1):78-85
pubmed: 19744569
Br J Haematol. 2005 Aug;130(3):363-72
pubmed: 16042685
Lancet. 2002 Jun 15;359(9323):2065-71
pubmed: 12086759
J Clin Oncol. 2011 Apr 1;29(10):1342-8
pubmed: 21321299
Lancet Oncol. 2011 Apr;12(4):361-8
pubmed: 21440503
Lancet Oncol. 2014 Jun;15(7):757-66
pubmed: 24827808
Bone Marrow Transplant. 2003 Mar;31(6):441-6
pubmed: 12665838
Blood. 2012 Nov 15;120(20):4256-62
pubmed: 23007405
N Engl J Med. 2017 Dec 28;377(26):2531-2544
pubmed: 29226797
N Engl J Med. 2015 Jan 22;372(4):311-9
pubmed: 25482239
Blood. 2014 Jun 5;123(23):3664-71
pubmed: 24744269