Brazilian experience using high-dose sequential therapy (HDS) followed by autologous hematopoietic stem cell transplantation (ASCT) for malignant lymphomas
Experiência brasileira utilizando terapia sequencial de alta dose seguido de transplante autólogo de célula-tronco hematopoética para linfomas malignos
Rev. bras. hematol. hemoter; 31 (supl.2), 2009
Publication year: 2009
Using the overall survival (OS), disease free survival (DFS) and progression free survival (PFS), as well as associated toxicity, the purpose of this work was to evaluate the effectiveness of HDS followed by ASCT as salvage therapy. A retrospective analysis was performed of 106 patients with high grade non-Hodgkin lymphoma receiving HDS followed by ASCT, between 1998 and 2006. Median age was 45 years (Range: 8-65), with 66 (62 percent) men.
Histopathological classification was:
78 percent DLBCL patients, 12 percent T and anaplastic and 9 percent Mantle cell lymphomas; 87 percent had B cell and 12 percent T cell lymphomas; 83 percent were stage III-IV (Ann Arbor Staging), 63 percent had B symptoms, 32 percent had bone marrow involvement, 62 percent bulky disease and 42 percent high-intermediate or high risk IPI. After HDCY, 9 patients died, 7 from toxicity and 2 from sepsis. Eighty patients underwent ASCT, 47 percent were in complete remission (CR) and 15 percent died, all from toxicity. Their OS was 45 percent over 8 years. During the follow-up, another 35 patients died [4 CR, 1 partial response (PR), 2 relapsed disease (RD) and 28 disease progression (DP)], 11 (31 percent) had not performed ASCT. OS was 37 percent; DFS was 49 percent and PFS 28 percent. OS by diagnosis was 42 percent for DLBCL, 40 percent for T-cell (8 y) and 20 percent for Mantle Cell (6 y) (P=NS). OS by B symptom patients was 22 percent vs. 58 percent (P=0.002) and PFS was 23 percent vs. 37 percent (P=0.03). Patients who achieved CR after HDCY (38) had significantly better OS and PFS (38 percent and 17 percent) than patients who remained in DP (P<0.0001). Cox Regression demonstrated therapeutic lines before HDCY (Relative risk - RR = 1.41; CI 95 percent: 1.04-1.90; P= 0.02) and PD both before (RR = 2.70; CI 95 percent: 1.49-4.91, P<0.001) and after HDCY (RR = 5.38; 95 percent CI: 2.93-9.87; P<0.0001).Conclusions:
Our study suggests HDS is an efficient treatment to ...
A proposta deste trabalho foi avaliar a eficácia da HDS seguida do transplante autólogo como terapia de salvamento através da sobrevida global, livre de doença e livre de progressão bem como sua toxicidade. Realizou-se estudo retrospectivo com 106 pacientes com LNH de alto grau de malignidade entre 1998 e 2006. A mediana de idade foi 45 anos (8-65); 62 por cento homens; DLBCL, 78 por cento; 12 por cento, T e anaplásico e 9 por cento, linfoma da zona do manto; 87 por cento, células B; 83 por cento estádios III-IV; 63 por cento com sintomas B; 32 por cento com infiltração da medula óssea ao diagnóstico; 62 por cento com grande massa e 42 por cento com IPI de alto risco ou intermediário. Após alta dose de ciclofosfamida (HDCY), nove pacientes faleceram. Oitenta pacientes realizaram o transplante, sendo que 47 por cento estavam em RC e 15 por cento faleceram devido à toxicidade. A sobrevida global foi de 45 por cento em oito anos para estes pacientes. Trinta e cinco pacientes não realizaram o transplante por causas diversas. Sobrevida global para todos os pacientes foi de 42 por cento, DLBCL, 40 por cento; T-cell, 40 por cento e zona do manto, 20 por cento (P=NS). Pacientes que obtiveram RC após HDCY tiveram melhor sobrevida global e livre de progressão (38 por cento e 17 por cento, respectivamente) do que os que permaneceram em PD (P<0.0001). O modelo de Cox resultou que o número de linhas terapêuticas antes da HDCY (RR 1.