Tandem high dose chemotherapy for non-hodgkin's lymphoma and hodgkin's disease utilizing cyclophosphamide, etoposide and carboplatin followed by melphalan and carboplatin with autologous stem cell transplantation

Jeffrey Andrey, Carol Burian, Robert McMillan, William E. Miller, Barry Meisenberg, James R. Mason

Research output: Contribution to journalArticle

Abstract

Introduction: 48 patients (26 men, 22 women) with relapsed NHL (median age 49 years) and 7 patients (4 men, 3 women) with relapsed HD (median age 37 years) received high dose chemotherapy and autologous stem cell transplantation at Scripps Clinic from February 1995 through January 2000. Regimen: All patients received cyclophosphamide (1500 mg/m2/d x 4d), etoposide (450 mg/m2/d x 4d), and carboplatin (300 mg/m2/d x 4d)(CVCb). Following recovery from this treatment cycle, 23 patients with NHL and 2 patients with HD received melphalan (70 mg/m2/d x 2d) and carboplatin (400 mg/m2/d x 3d)(MCb). Autologous peripheral blood progenitor cells were reinfused after each cycle. Toxicity: No regimen-related mortality was observed. Grade 3 mucositis and grade 2 nausea/ vomiting/diarrhea were the most common toxicities. Two patients experienced grade 4 hepatotoxicity, two patients experienced grade 4 cardiotoxicity, and one patient experienced grade 4 pulmonary toxicity after the CVCb cycle. Grade 4 hepatotoxicity and pulmonary toxicity were seen in two different patients after the MCb cycle. Results: 5/7 HD patients remain alive and free of disease at 48 months. 5/7 patients with low grade NHL are alive, but all have relapsed (median disease free survival, 33 mos; median overall survival, 34 mos). Of 28 patients with intermediate grade NHL, 17 received CVCb, 3 were sensitive induction failures. 11 patients received the additional MCb cycle, 6 were sensitive induction failures. At 48 months, disease-free and overall survivals are 65% and 75% respectively for patients receiving CVCb. Disease-free and overall survivals are 35% at 48 months for patients receiving CVCb plus MCb. The disease-free and overall survival differences between groups were not statistically significant (p=0.14). Conclusions: 1) The CVCb regimen as administered here was well tolerated and no regimen related mortality was noted. 2) For patients with intermediate grade NHL, a second cycle of MCb administered after CVCb did not improve disease free or overall survival. 3) The CVCb regimen is effective therapy for the small number of HD patients treated. A larger number of patients would be needed to assess the impact of a second MCb cycle on outcomes.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART II
StatePublished - 2000
Externally publishedYes

Fingerprint

Melphalan
Chemotherapy
Carboplatin
Stem Cell Transplantation
Etoposide
Stem cells
Hodgkin Disease
Non-Hodgkin's Lymphoma
Cyclophosphamide
Drug Therapy
Toxicity
Disease-Free Survival
Blood
Recovery
Lung
Mucositis
Survival
Mortality

ASJC Scopus subject areas

  • Hematology

Cite this

Tandem high dose chemotherapy for non-hodgkin's lymphoma and hodgkin's disease utilizing cyclophosphamide, etoposide and carboplatin followed by melphalan and carboplatin with autologous stem cell transplantation. / Andrey, Jeffrey; Burian, Carol; McMillan, Robert; Miller, William E.; Meisenberg, Barry; Mason, James R.

In: Blood, Vol. 96, No. 11 PART II, 2000.

Research output: Contribution to journalArticle

Andrey, Jeffrey ; Burian, Carol ; McMillan, Robert ; Miller, William E. ; Meisenberg, Barry ; Mason, James R. / Tandem high dose chemotherapy for non-hodgkin's lymphoma and hodgkin's disease utilizing cyclophosphamide, etoposide and carboplatin followed by melphalan and carboplatin with autologous stem cell transplantation. In: Blood. 2000 ; Vol. 96, No. 11 PART II.
@article{4d835b86df994b2a819f8017dc49a5d4,
title = "Tandem high dose chemotherapy for non-hodgkin's lymphoma and hodgkin's disease utilizing cyclophosphamide, etoposide and carboplatin followed by melphalan and carboplatin with autologous stem cell transplantation",
abstract = "Introduction: 48 patients (26 men, 22 women) with relapsed NHL (median age 49 years) and 7 patients (4 men, 3 women) with relapsed HD (median age 37 years) received high dose chemotherapy and autologous stem cell transplantation at Scripps Clinic from February 1995 through January 2000. Regimen: All patients received cyclophosphamide (1500 mg/m2/d x 4d), etoposide (450 mg/m2/d x 4d), and carboplatin (300 mg/m2/d x 4d)(CVCb). Following recovery from this treatment cycle, 23 patients with NHL and 2 patients with HD received melphalan (70 mg/m2/d x 2d) and carboplatin (400 mg/m2/d x 3d)(MCb). Autologous peripheral blood progenitor cells were reinfused after each cycle. Toxicity: No regimen-related mortality was observed. Grade 3 mucositis and grade 2 nausea/ vomiting/diarrhea were the most common toxicities. Two patients experienced grade 4 hepatotoxicity, two patients experienced grade 4 cardiotoxicity, and one patient experienced grade 4 pulmonary toxicity after the CVCb cycle. Grade 4 hepatotoxicity and pulmonary toxicity were seen in two different patients after the MCb cycle. Results: 5/7 HD patients remain alive and free of disease at 48 months. 5/7 patients with low grade NHL are alive, but all have relapsed (median disease free survival, 33 mos; median overall survival, 34 mos). Of 28 patients with intermediate grade NHL, 17 received CVCb, 3 were sensitive induction failures. 11 patients received the additional MCb cycle, 6 were sensitive induction failures. At 48 months, disease-free and overall survivals are 65{\%} and 75{\%} respectively for patients receiving CVCb. Disease-free and overall survivals are 35{\%} at 48 months for patients receiving CVCb plus MCb. The disease-free and overall survival differences between groups were not statistically significant (p=0.14). Conclusions: 1) The CVCb regimen as administered here was well tolerated and no regimen related mortality was noted. 2) For patients with intermediate grade NHL, a second cycle of MCb administered after CVCb did not improve disease free or overall survival. 3) The CVCb regimen is effective therapy for the small number of HD patients treated. A larger number of patients would be needed to assess the impact of a second MCb cycle on outcomes.",
author = "Jeffrey Andrey and Carol Burian and Robert McMillan and Miller, {William E.} and Barry Meisenberg and Mason, {James R.}",
year = "2000",
language = "English (US)",
volume = "96",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "11 PART II",

}

TY - JOUR

T1 - Tandem high dose chemotherapy for non-hodgkin's lymphoma and hodgkin's disease utilizing cyclophosphamide, etoposide and carboplatin followed by melphalan and carboplatin with autologous stem cell transplantation

AU - Andrey, Jeffrey

AU - Burian, Carol

AU - McMillan, Robert

AU - Miller, William E.

AU - Meisenberg, Barry

AU - Mason, James R.

PY - 2000

Y1 - 2000

N2 - Introduction: 48 patients (26 men, 22 women) with relapsed NHL (median age 49 years) and 7 patients (4 men, 3 women) with relapsed HD (median age 37 years) received high dose chemotherapy and autologous stem cell transplantation at Scripps Clinic from February 1995 through January 2000. Regimen: All patients received cyclophosphamide (1500 mg/m2/d x 4d), etoposide (450 mg/m2/d x 4d), and carboplatin (300 mg/m2/d x 4d)(CVCb). Following recovery from this treatment cycle, 23 patients with NHL and 2 patients with HD received melphalan (70 mg/m2/d x 2d) and carboplatin (400 mg/m2/d x 3d)(MCb). Autologous peripheral blood progenitor cells were reinfused after each cycle. Toxicity: No regimen-related mortality was observed. Grade 3 mucositis and grade 2 nausea/ vomiting/diarrhea were the most common toxicities. Two patients experienced grade 4 hepatotoxicity, two patients experienced grade 4 cardiotoxicity, and one patient experienced grade 4 pulmonary toxicity after the CVCb cycle. Grade 4 hepatotoxicity and pulmonary toxicity were seen in two different patients after the MCb cycle. Results: 5/7 HD patients remain alive and free of disease at 48 months. 5/7 patients with low grade NHL are alive, but all have relapsed (median disease free survival, 33 mos; median overall survival, 34 mos). Of 28 patients with intermediate grade NHL, 17 received CVCb, 3 were sensitive induction failures. 11 patients received the additional MCb cycle, 6 were sensitive induction failures. At 48 months, disease-free and overall survivals are 65% and 75% respectively for patients receiving CVCb. Disease-free and overall survivals are 35% at 48 months for patients receiving CVCb plus MCb. The disease-free and overall survival differences between groups were not statistically significant (p=0.14). Conclusions: 1) The CVCb regimen as administered here was well tolerated and no regimen related mortality was noted. 2) For patients with intermediate grade NHL, a second cycle of MCb administered after CVCb did not improve disease free or overall survival. 3) The CVCb regimen is effective therapy for the small number of HD patients treated. A larger number of patients would be needed to assess the impact of a second MCb cycle on outcomes.

AB - Introduction: 48 patients (26 men, 22 women) with relapsed NHL (median age 49 years) and 7 patients (4 men, 3 women) with relapsed HD (median age 37 years) received high dose chemotherapy and autologous stem cell transplantation at Scripps Clinic from February 1995 through January 2000. Regimen: All patients received cyclophosphamide (1500 mg/m2/d x 4d), etoposide (450 mg/m2/d x 4d), and carboplatin (300 mg/m2/d x 4d)(CVCb). Following recovery from this treatment cycle, 23 patients with NHL and 2 patients with HD received melphalan (70 mg/m2/d x 2d) and carboplatin (400 mg/m2/d x 3d)(MCb). Autologous peripheral blood progenitor cells were reinfused after each cycle. Toxicity: No regimen-related mortality was observed. Grade 3 mucositis and grade 2 nausea/ vomiting/diarrhea were the most common toxicities. Two patients experienced grade 4 hepatotoxicity, two patients experienced grade 4 cardiotoxicity, and one patient experienced grade 4 pulmonary toxicity after the CVCb cycle. Grade 4 hepatotoxicity and pulmonary toxicity were seen in two different patients after the MCb cycle. Results: 5/7 HD patients remain alive and free of disease at 48 months. 5/7 patients with low grade NHL are alive, but all have relapsed (median disease free survival, 33 mos; median overall survival, 34 mos). Of 28 patients with intermediate grade NHL, 17 received CVCb, 3 were sensitive induction failures. 11 patients received the additional MCb cycle, 6 were sensitive induction failures. At 48 months, disease-free and overall survivals are 65% and 75% respectively for patients receiving CVCb. Disease-free and overall survivals are 35% at 48 months for patients receiving CVCb plus MCb. The disease-free and overall survival differences between groups were not statistically significant (p=0.14). Conclusions: 1) The CVCb regimen as administered here was well tolerated and no regimen related mortality was noted. 2) For patients with intermediate grade NHL, a second cycle of MCb administered after CVCb did not improve disease free or overall survival. 3) The CVCb regimen is effective therapy for the small number of HD patients treated. A larger number of patients would be needed to assess the impact of a second MCb cycle on outcomes.

UR - http://www.scopus.com/inward/record.url?scp=33748573646&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748573646&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:33748573646

VL - 96

JO - Blood

JF - Blood

SN - 0006-4971

IS - 11 PART II

ER -