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Autologous stem cell transplantation for refractory or poor-risk relapsed Hodgkin's lymphoma: effect of the specific high-dose chemotherapy regimen on outcome.
Nieto, Yago; Popat, Uday; Anderlini, Paolo; Valdez, Ben; Andersson, Borje; Liu, Ping; Hosing, Chitra; Shpall, Elizabeth J; Alousi, Amin; Kebriaei, Partow; Qazilbash, Muzaffar; Parmar, Simrit; Bashir, Qaiser; Shah, Nina; Khouri, Issa; Rondon, Gabriela; Champlin, Richard; Jones, Roy B.
Afiliação
  • Nieto Y; Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. ynieto@mdanderson.org
Biol Blood Marrow Transplant ; 19(3): 410-7, 2013 Mar.
Article em En | MEDLINE | ID: mdl-23128322
More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin's lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS = 2.2, P = .004, HR for OS = 3.1, P = .0001), and >1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença de Hodgkin / Protocolos de Quimioterapia Combinada Antineoplásica / Transplante de Células-Tronco Hematopoéticas / Condicionamento Pré-Transplante Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2013 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença de Hodgkin / Protocolos de Quimioterapia Combinada Antineoplásica / Transplante de Células-Tronco Hematopoéticas / Condicionamento Pré-Transplante Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2013 Tipo de documento: Article