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 D.
AU - Blackford, Amanda L.
AU - Seifter, Eric J.
AU - Davis-Sproul, Janice M.
AU - Gore, Steven D.
AU - Ambinder, Richard F.
N1 - Funding Information:
Financial disclosure: This work was supported by the National Institutes of Health ( P01 CA015396 to R.J.J., K23 CA124465 to Y.L.K.) and National Cancer Institute Lymphoma SPORE ( P50 CA09688 to R.F.A.). Presented in part at the 2003 American Society of Hematology Annual Meeting.
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
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U2 - 10.1016/j.bbmt.2010.07.007
DO - 10.1016/j.bbmt.2010.07.007
M3 - Article
C2 - 20655387
AN - SCOPUS:79551680909
SN - 1083-8791
VL - 17
SP - 365
EP - 373
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 3
ER -