Extended Follow-up of Autologous Bone Marrow Transplantation with 4-Hydroperoxycyclophosphamide (4-HC) Purging for Indolent or Transformed Non-Hodgkin Lymphomas

Yvette L. Kasamon, Richard J Jones, Christopher Gocke, Amanda L. Blackford, Eric J. Seifter, Janice Davis Sproul, Steven D. Gore, Richard F Ambinder

Research output: Contribution to journalArticle

Abstract

Autologous blood or marrow transplantation (ABMT) for low-grade lymphomas can prolong event-free survival (EFS) but requires long-term follow-up. We report one of the longest follow-ups to a prospective transplantation study in such diseases. On a phase II study, 80 patients with low-grade, transformed, or mantle cell lymphoma received ABMT with 4-hydroperoxycyclophosphamide (4-HC) purging as part of initial or salvage therapy. Diagnoses included nontransformed follicular lymphoma in 63% and transformed lymphoma in 15%. With 16.6-year median follow-up for survival, actuarial 10-year EFS and overall survival (OS) were 34% (95% confidence interval [CI], 25%-46%) and 45% (35%-57%). Median EFS and OS were 3.0 and 8.0 years. Early nonrelapse mortality incidence was 8%; myelodysplastic syndrome or leukemia incidence was 4%. Most relapses occurred within 3 years, with a median time to diagnosis of relapse of 1.8 years (range: 0.1-15.6 years). On multivariate analysis, age >50 years, ≥3 prior chemotherapy regimens, and ABMT after relapse were associated with significantly inferior survival. Fifteen patients (19%) were event-free >15 years after transplantation, raising the possibility of a plateau in the progression-free survival curve. Thus, 4-HC-purged ABMT can produce extended remissions in a subgroup of patients with indolent lymphomas.

Original languageEnglish (US)
Pages (from-to)365-373
Number of pages9
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

perfosfamide
Autologous Transplantation
Bone Marrow Transplantation
Non-Hodgkin's Lymphoma
Transplantation
Disease-Free Survival
Bone Marrow
Survival
Recurrence
Lymphoma
Mantle-Cell Lymphoma
Salvage Therapy
Follicular Lymphoma
Myelodysplastic Syndromes
Incidence
Leukemia
Multivariate Analysis

Keywords

  • 4-Hydroperoxycyclophosphamide (4-HC)
  • Autologous transplantation
  • Lymphoma
  • Purging

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

@article{5a59cc7239f5411b8b5b9ad58e6451e5,
title = "Extended Follow-up of Autologous Bone Marrow Transplantation with 4-Hydroperoxycyclophosphamide (4-HC) Purging for Indolent or Transformed Non-Hodgkin Lymphomas",
abstract = "Autologous blood or marrow transplantation (ABMT) for low-grade lymphomas can prolong event-free survival (EFS) but requires long-term follow-up. We report one of the longest follow-ups to a prospective transplantation study in such diseases. On a phase II study, 80 patients with low-grade, transformed, or mantle cell lymphoma received ABMT with 4-hydroperoxycyclophosphamide (4-HC) purging as part of initial or salvage therapy. Diagnoses included nontransformed follicular lymphoma in 63{\%} and transformed lymphoma in 15{\%}. With 16.6-year median follow-up for survival, actuarial 10-year EFS and overall survival (OS) were 34{\%} (95{\%} confidence interval [CI], 25{\%}-46{\%}) and 45{\%} (35{\%}-57{\%}). Median EFS and OS were 3.0 and 8.0 years. Early nonrelapse mortality incidence was 8{\%}; myelodysplastic syndrome or leukemia incidence was 4{\%}. Most relapses occurred within 3 years, with a median time to diagnosis of relapse of 1.8 years (range: 0.1-15.6 years). On multivariate analysis, age >50 years, ≥3 prior chemotherapy regimens, and ABMT after relapse were associated with significantly inferior survival. Fifteen patients (19{\%}) were event-free >15 years after transplantation, raising the possibility of a plateau in the progression-free survival curve. Thus, 4-HC-purged ABMT can produce extended remissions in a subgroup of patients with indolent lymphomas.",
keywords = "4-Hydroperoxycyclophosphamide (4-HC), Autologous transplantation, Lymphoma, Purging",
author = "Kasamon, {Yvette L.} and Jones, {Richard J} and Christopher Gocke and Blackford, {Amanda L.} and Seifter, {Eric J.} and {Davis Sproul}, Janice and Gore, {Steven D.} and Ambinder, {Richard F}",
year = "2011",
month = "3",
doi = "10.1016/j.bbmt.2010.07.007",
language = "English (US)",
volume = "17",
pages = "365--373",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Extended Follow-up of Autologous Bone Marrow Transplantation with 4-Hydroperoxycyclophosphamide (4-HC) Purging for Indolent or Transformed Non-Hodgkin Lymphomas

AU - Kasamon, Yvette L.

AU - Jones, Richard J

AU - Gocke, Christopher

AU - Blackford, Amanda L.

AU - Seifter, Eric J.

AU - Davis Sproul, Janice

AU - Gore, Steven D.

AU - Ambinder, Richard F

PY - 2011/3

Y1 - 2011/3

N2 - Autologous blood or marrow transplantation (ABMT) for low-grade lymphomas can prolong event-free survival (EFS) but requires long-term follow-up. We report one of the longest follow-ups to a prospective transplantation study in such diseases. On a phase II study, 80 patients with low-grade, transformed, or mantle cell lymphoma received ABMT with 4-hydroperoxycyclophosphamide (4-HC) purging as part of initial or salvage therapy. Diagnoses included nontransformed follicular lymphoma in 63% and transformed lymphoma in 15%. With 16.6-year median follow-up for survival, actuarial 10-year EFS and overall survival (OS) were 34% (95% confidence interval [CI], 25%-46%) and 45% (35%-57%). Median EFS and OS were 3.0 and 8.0 years. Early nonrelapse mortality incidence was 8%; myelodysplastic syndrome or leukemia incidence was 4%. Most relapses occurred within 3 years, with a median time to diagnosis of relapse of 1.8 years (range: 0.1-15.6 years). On multivariate analysis, age >50 years, ≥3 prior chemotherapy regimens, and ABMT after relapse were associated with significantly inferior survival. Fifteen patients (19%) were event-free >15 years after transplantation, raising the possibility of a plateau in the progression-free survival curve. Thus, 4-HC-purged ABMT can produce extended remissions in a subgroup of patients with indolent lymphomas.

AB - Autologous blood or marrow transplantation (ABMT) for low-grade lymphomas can prolong event-free survival (EFS) but requires long-term follow-up. We report one of the longest follow-ups to a prospective transplantation study in such diseases. On a phase II study, 80 patients with low-grade, transformed, or mantle cell lymphoma received ABMT with 4-hydroperoxycyclophosphamide (4-HC) purging as part of initial or salvage therapy. Diagnoses included nontransformed follicular lymphoma in 63% and transformed lymphoma in 15%. With 16.6-year median follow-up for survival, actuarial 10-year EFS and overall survival (OS) were 34% (95% confidence interval [CI], 25%-46%) and 45% (35%-57%). Median EFS and OS were 3.0 and 8.0 years. Early nonrelapse mortality incidence was 8%; myelodysplastic syndrome or leukemia incidence was 4%. Most relapses occurred within 3 years, with a median time to diagnosis of relapse of 1.8 years (range: 0.1-15.6 years). On multivariate analysis, age >50 years, ≥3 prior chemotherapy regimens, and ABMT after relapse were associated with significantly inferior survival. Fifteen patients (19%) were event-free >15 years after transplantation, raising the possibility of a plateau in the progression-free survival curve. Thus, 4-HC-purged ABMT can produce extended remissions in a subgroup of patients with indolent lymphomas.

KW - 4-Hydroperoxycyclophosphamide (4-HC)

KW - Autologous transplantation

KW - Lymphoma

KW - Purging

UR - http://www.scopus.com/inward/record.url?scp=79551680909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79551680909&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2010.07.007

DO - 10.1016/j.bbmt.2010.07.007

M3 - Article

VL - 17

SP - 365

EP - 373

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 3

ER -