Immunologic recovery following autologous stem-cell transplantation with pre- and posttransplantation rituximab for low-grade or mantle cell lymphoma

Y. L. Kasamon, Richard J Jones, Robert A Brodsky, Ephraim J Fuchs, W. Matsui, Leo Luznik, Jonathan Powell, A. L. Blackford, Amy Goodrich, Christopher Gocke, R. A. Abrams, Richard F Ambinder, I. W. Flinn

Research output: Contribution to journalArticle

Abstract

Background: Rituximab may improve transplant outcomes but may delay immunologic recovery. Patients and methods: Seventy-seven patients with low-grade or mantle cell lymphoma received autologous stemcell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilizationdose cyclophosphamide, then weekly for four doses after count recovery from ASCT. Immune reconstitution was assessed. Results: Sixty percent of transplants occurred in first remission. Actuarial event-free survival (EFS) and overall survival (OS) were 60% and 73%, respectively, at 5 years, with 7.2-year median follow-up for OS in surviving patients. Median EFS was 8.3 years. Older age and transformed lymphomas were independently associated with inferior EFS, whereas day 60 lymphocyte counts did not predict EFS or late infections. Early and late transplant-related mortality was 1% and 8%, with secondary leukemia in two patients. B-cell counts recovered by 1-2 years; however, the median IgG level remained low at 2 years. Late-onset idiopathic neutropenia, generally inconsequential, was noted in 43%. Conclusion: ASCT with rituximab can produce durable remissions on follow-up out to 10 years. Major infections do not appear to be significantly increased or to be predicted by immune monitoring.

Original languageEnglish (US)
Pages (from-to)1203-1210
Number of pages8
JournalAnnals of Oncology
Volume21
Issue number6
DOIs
StatePublished - Oct 30 2009

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Mantle-Cell Lymphoma
Stem Cell Transplantation
Disease-Free Survival
Autologous Transplantation
Transplants
Immunologic Monitoring
Survival
Lymphocyte Count
Infection
Neutropenia
Cyclophosphamide
Lymphoma
Leukemia
B-Lymphocytes
Cell Count
Immunoglobulin G
Mortality
Rituximab

Keywords

  • Immune reconstitution
  • Lymphoma
  • Rituximab
  • Transplantation

ASJC Scopus subject areas

  • Oncology
  • Hematology
  • Medicine(all)

Cite this

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title = "Immunologic recovery following autologous stem-cell transplantation with pre- and posttransplantation rituximab for low-grade or mantle cell lymphoma",
abstract = "Background: Rituximab may improve transplant outcomes but may delay immunologic recovery. Patients and methods: Seventy-seven patients with low-grade or mantle cell lymphoma received autologous stemcell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilizationdose cyclophosphamide, then weekly for four doses after count recovery from ASCT. Immune reconstitution was assessed. Results: Sixty percent of transplants occurred in first remission. Actuarial event-free survival (EFS) and overall survival (OS) were 60{\%} and 73{\%}, respectively, at 5 years, with 7.2-year median follow-up for OS in surviving patients. Median EFS was 8.3 years. Older age and transformed lymphomas were independently associated with inferior EFS, whereas day 60 lymphocyte counts did not predict EFS or late infections. Early and late transplant-related mortality was 1{\%} and 8{\%}, with secondary leukemia in two patients. B-cell counts recovered by 1-2 years; however, the median IgG level remained low at 2 years. Late-onset idiopathic neutropenia, generally inconsequential, was noted in 43{\%}. Conclusion: ASCT with rituximab can produce durable remissions on follow-up out to 10 years. Major infections do not appear to be significantly increased or to be predicted by immune monitoring.",
keywords = "Immune reconstitution, Lymphoma, Rituximab, Transplantation",
author = "Kasamon, {Y. L.} and Jones, {Richard J} and Brodsky, {Robert A} and Fuchs, {Ephraim J} and W. Matsui and Leo Luznik and Jonathan Powell and Blackford, {A. L.} and Amy Goodrich and Christopher Gocke and Abrams, {R. A.} and Ambinder, {Richard F} and Flinn, {I. W.}",
year = "2009",
month = "10",
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doi = "10.1093/annonc/mdp484",
language = "English (US)",
volume = "21",
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TY - JOUR

T1 - Immunologic recovery following autologous stem-cell transplantation with pre- and posttransplantation rituximab for low-grade or mantle cell lymphoma

AU - Kasamon, Y. L.

AU - Jones, Richard J

AU - Brodsky, Robert A

AU - Fuchs, Ephraim J

AU - Matsui, W.

AU - Luznik, Leo

AU - Powell, Jonathan

AU - Blackford, A. L.

AU - Goodrich, Amy

AU - Gocke, Christopher

AU - Abrams, R. A.

AU - Ambinder, Richard F

AU - Flinn, I. W.

PY - 2009/10/30

Y1 - 2009/10/30

N2 - Background: Rituximab may improve transplant outcomes but may delay immunologic recovery. Patients and methods: Seventy-seven patients with low-grade or mantle cell lymphoma received autologous stemcell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilizationdose cyclophosphamide, then weekly for four doses after count recovery from ASCT. Immune reconstitution was assessed. Results: Sixty percent of transplants occurred in first remission. Actuarial event-free survival (EFS) and overall survival (OS) were 60% and 73%, respectively, at 5 years, with 7.2-year median follow-up for OS in surviving patients. Median EFS was 8.3 years. Older age and transformed lymphomas were independently associated with inferior EFS, whereas day 60 lymphocyte counts did not predict EFS or late infections. Early and late transplant-related mortality was 1% and 8%, with secondary leukemia in two patients. B-cell counts recovered by 1-2 years; however, the median IgG level remained low at 2 years. Late-onset idiopathic neutropenia, generally inconsequential, was noted in 43%. Conclusion: ASCT with rituximab can produce durable remissions on follow-up out to 10 years. Major infections do not appear to be significantly increased or to be predicted by immune monitoring.

AB - Background: Rituximab may improve transplant outcomes but may delay immunologic recovery. Patients and methods: Seventy-seven patients with low-grade or mantle cell lymphoma received autologous stemcell transplantation (ASCT) on a phase II study. Rituximab 375 mg/m2 was administered 3 days before mobilizationdose cyclophosphamide, then weekly for four doses after count recovery from ASCT. Immune reconstitution was assessed. Results: Sixty percent of transplants occurred in first remission. Actuarial event-free survival (EFS) and overall survival (OS) were 60% and 73%, respectively, at 5 years, with 7.2-year median follow-up for OS in surviving patients. Median EFS was 8.3 years. Older age and transformed lymphomas were independently associated with inferior EFS, whereas day 60 lymphocyte counts did not predict EFS or late infections. Early and late transplant-related mortality was 1% and 8%, with secondary leukemia in two patients. B-cell counts recovered by 1-2 years; however, the median IgG level remained low at 2 years. Late-onset idiopathic neutropenia, generally inconsequential, was noted in 43%. Conclusion: ASCT with rituximab can produce durable remissions on follow-up out to 10 years. Major infections do not appear to be significantly increased or to be predicted by immune monitoring.

KW - Immune reconstitution

KW - Lymphoma

KW - Rituximab

KW - Transplantation

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