14 results on '"Bolwell, Brian J."'
Search Results
2. Efficacy of Standard Dose R-CHOP Alternating With R-HDAC Followed by Autologous Hematopoietic Cell Transplantation as Initial Therapy of Mantle Cell Lymphoma, a Single-Institution Experience.
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Sawalha Y, Hill BT, Rybicki LA, Sun D, Dean RM, Jagadeesh D, Hamilton BK, Gerds AT, Sobecks RM, Andresen S, Liu HK, Majhail NS, Pohlman B, Kalaycio ME, Bolwell BJ, and Smith MR
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols pharmacology, Female, Humans, Lymphoma, Mantle-Cell drug therapy, Lymphoma, Mantle-Cell pathology, Male, Middle Aged, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Hematopoietic Stem Cell Transplantation methods, Lymphoma, Mantle-Cell therapy, Transplantation Conditioning methods
- Abstract
Background: Young fit patients with mantle cell lymphoma (MCL) are commonly treated with induction chemotherapy followed by high-dose chemotherapy and autologous hematopoietic cell transplantation (AHCT). Induction regimens with modifications of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and/or incorporation of high-dose cytarabine (HDAC) appear more effective than R-CHOP alone., Patients and Methods: We adopted a modification of the Nordic protocol using standard, rather than higher dose R-CHOP, alternating with HDAC (rituximab plus HDAC), for 3 cycles each or, for patients already treated with R-CHOP alone before referral for AHCT, an additional 2 cycles of rituximab plus HDAC. We herein report our experience with 28 patients treated with this regimen who proceeded to AHCT, and compare their outcomes with patients treated with either standard-dose R-CHOP (n = 38) or R-HCVAD/MA (cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with methotrexate, and cytarabine; n = 21), before AHCT., Results: With a median follow-up duration of 26 months, our data show that this modification of the Nordic regimen is a highly effective pre-AHCT first-line therapy for MCL (3-year progression-free and overall survival rates of 69% and 75%, respectively)., Conclusion: By using a less intense induction, this regimen can serve as a platform for combined use of novel agents, with less risk of additive toxicity., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2018
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3. Comparative Effectiveness of Busulfan and Fludarabine versus Fludarabine and 400 cGy Total Body Irradiation Conditioning Regimens for Acute Myeloid Leukemia/Myelodysplastic Syndrome.
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Mustafa Ali M, Abounader DM, Rybicki LA, Yurch MA, Starn J, Ferraro C, Winslow V, Hamilton BK, Gerds AT, Liu H, Dean R, Hill BT, Pohlman B, Andresen S, Hanna R, Kalaycio M, Bolwell BJ, Majhail NS, and Sobecks RM
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- Adult, Aged, Busulfan therapeutic use, Erythrocyte Transfusion, Female, Graft vs Host Disease etiology, Humans, Leukemia, Myeloid, Acute mortality, Male, Middle Aged, Myelodysplastic Syndromes mortality, Quality of Life, Recurrence, Survival Analysis, Transplantation Conditioning standards, Vidarabine analogs & derivatives, Vidarabine therapeutic use, Whole-Body Irradiation methods, Leukemia, Myeloid, Acute therapy, Myelodysplastic Syndromes therapy, Transplantation Conditioning methods
- Abstract
Allogeneic hematopoietic cell transplantation conditioning regimen intensity has varied for patients with acute myeloid leukemia and myelodysplastic syndrome. A comparative effectiveness analysis was performed to assess outcomes of busulfan and fludarabine (BuFlu) versus those of fludarabine and 400 cGy total body irradiation (FluTBI) conditioning. Thirty-three subjects received BuFlu and 38 received FluTBI. The BuFlu group received more red blood cell transfusions (P = .02) and had a longer time to platelet recovery (P = .004). There were no differences between the regimens regarding incidence of acute or chronic graft-versus-host disease (GVHD), quality of life, or 2-year outcome estimates for relapse (48; 95% confidence interval [CI], 30 to 64 and 50; 95% CI, 33 to 65), nonrelapse mortality (29; 95% CI, 14 to 45 and 29; 95% CI, 15 to 44), relapse-free survival (27; 95% CI, 13 to 43 and 29; 95% CI, 16 to 44), and overall survival (35; 95% CI, 19 to 51; and 37; 95% CI, 22 to 52), respectively. These comparable outcomes have implications for health care resource utilization. Future prospective investigation comparing these regimens with larger patient cohorts and additional strategies to prevent relapse and limit toxicities as well as cost-effectiveness analyses are warranted., (Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
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- 2017
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4. Comparison of outcomes of allogeneic transplantation for chronic myeloid leukemia with cyclophosphamide in combination with intravenous busulfan, oral busulfan, or total body irradiation.
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Copelan EA, Avalos BR, Ahn KW, Zhu X, Gale RP, Grunwald MR, Hamadani M, Hamilton BK, Hale GA, Marks DI, Waller EK, Savani BN, Costa LJ, Ramanathan M, Cahn JY, Khoury HJ, Weisdorf DJ, Inamoto Y, Kamble RT, Schouten HC, Wirk B, Litzow MR, Aljurf MD, van Besien KW, Ustun C, Bolwell BJ, Bredeson CN, Fasan O, Ghosh N, Horowitz MM, Arora M, Szer J, Loren AW, Alyea EP, Cortes J, Maziarz RT, Kalaycio ME, and Saber W
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- Administration, Intravenous, Administration, Oral, Adolescent, Adult, Allografts, Disease-Free Survival, Female, Humans, Male, Middle Aged, Siblings, Survival Rate, Whole-Body Irradiation, Busulfan administration & dosage, Cyclophosphamide administration & dosage, Leukemia, Myelogenous, Chronic, BCR-ABL Positive mortality, Leukemia, Myelogenous, Chronic, BCR-ABL Positive therapy, Myeloablative Agonists administration & dosage, Transplantation Conditioning
- Abstract
Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P = .022) or oral Bu (RR, .39; P = .028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P = .025) or oral Bu (RR, .64; P = .017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI., (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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5. Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the center for international blood and marrow transplantation research.
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Foran JM, Pavletic SZ, Logan BR, Agovi-Johnson MA, Pérez WS, Bolwell BJ, Bornhäuser M, Bredeson CN, Cairo MS, Camitta BM, Copelan EA, Dehn J, Gale RP, George B, Gupta V, Hale GA, Lazarus HM, Litzow MR, Maharaj D, Marks DI, Martino R, Maziarz RT, Rowe JM, Rowlings PA, Savani BN, Savoie ML, Szer J, Waller EK, Wiernik PH, and Weisdorf DJ
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Follow-Up Studies, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Graft vs Host Disease pathology, Humans, Infant, International Cooperation, Leukemia, Myeloid, Acute immunology, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute pathology, Male, Middle Aged, Recurrence, Survival Analysis, Transplantation, Autologous, Transplantation, Homologous, Unrelated Donors, Antineoplastic Agents therapeutic use, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation methods, Leukemia, Myeloid, Acute therapy, Transplantation Conditioning
- Abstract
The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed., (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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6. Alternate donor hematopoietic cell transplantation (HCT) in non-Hodgkin lymphoma using lower intensity conditioning: a report from the CIBMTR.
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Hale GA, Shrestha S, Le-Rademacher J, Burns LJ, Gibson J, Inwards DJ, Freytes CO, Bolwell BJ, Hsu JW, Slavin S, Isola L, Rizzieri DA, Gale RP, Laport GG, Montoto S, Lazarus HM, and Hari PN
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Antilymphocyte Serum administration & dosage, Antilymphocyte Serum adverse effects, Chronic Disease, Female, Graft vs Host Disease immunology, Graft vs Host Disease mortality, HLA Antigens immunology, Histocompatibility Testing, Humans, Lymphocyte Depletion, Lymphoma, Non-Hodgkin immunology, Lymphoma, Non-Hodgkin mortality, Male, Middle Aged, Survival Analysis, Transplantation, Homologous, Unrelated Donors, Whole-Body Irradiation, Graft vs Host Disease therapy, Hematopoietic Stem Cell Transplantation, Lymphoma, Non-Hodgkin therapy, Registries, Transplantation Conditioning methods
- Abstract
We analyzed the outcomes of 248 (61% male) adult recipients of HLA-matched unrelated and HLA-mismatched related donor hematopoietic cell transplantation (HCT) for non-Hodgkin lymphoma (NHL) after reduced or lower intensity conditioning (RIC), reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1997 to 2004. Median age was 52 (range: 18-72 years); 31% had a Karnofsky performance score <90. Follicular NHL (43%) was the major histology. Incidence of grades II-IV acute graft-versus-host disease (aGVHD) was 43% at 100 days; and chronic GVHD (cGVHD) was 44% at 3 years. Treatment-related mortality (TRM) at 100 days was 24%. Three-year overall survival (OS) and progression-free survival (PFS) were 41% and 32%, respectively. In multivariate analysis, use of antithymocyte globulin (ATG) and HLA mismatch were associated with increased TRM. High-grade histology, ATG use, and chemotherapy resistance were associated with lower PFS. Older age, shorter interval from diagnosis to HCT, non-total body irridiation (TBI) conditioning regimens, ex vivo T cell depletion, and HLA-mismatched unrelated donors were associated with mortality. GVHD did not influence relapse or PFS. Older age, aggressive histology, and chemotherapy resistance correlated with poorer survival. For selected patients with NHL, lack of an available sibling donor should not be a barrier to allogeneic HCT., (Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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7. Risk factors for 30-day hospital readmission following myeloablative allogeneic hematopoietic cell transplantation (allo-HCT).
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Bejanyan N, Bolwell BJ, Lazaryan A, Rybicki L, Tench S, Duong H, Andresen S, Sobecks R, Dean R, Pohlman B, Kalaycio M, and Copelan EA
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- Adolescent, Adult, Aged, Female, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Humans, Length of Stay statistics & numerical data, Leukemia, Lymphoid immunology, Leukemia, Lymphoid mortality, Leukemia, Myeloid immunology, Leukemia, Myeloid mortality, Male, Middle Aged, Patient Discharge, Patient Readmission statistics & numerical data, Quality of Health Care, Recurrence, Retrospective Studies, Risk Factors, Survival Analysis, Transplantation, Homologous, Treatment Outcome, Whole-Body Irradiation, Hematopoietic Stem Cell Transplantation, Leukemia, Lymphoid therapy, Leukemia, Myeloid therapy, Transplantation Conditioning
- Abstract
Patient readmission within 30 days from discharge has been perceived by the Centers for Medicare and Medical Services as an indicator of poor healthcare quality for specific high-cost medical conditions. Patients who undergo allogeneic hematopoietic cell transplantation (allo-HCT) are often being readmitted. Our study identified the risk factors for 30-day readmission among 618 adult recipients of myeloablative allo-HCT from 1990 to 2009. Two hundred forty-two (39%) of 618 patients (median age = 42 years [range: 18-66]) were readmitted a median of 10 days (range: 1-30) from their hospital discharge. Median duration of readmission was 8 days (range: 0-103). Infections (n = 68), fever with or without identified source of infection (n = 63), gastrointestinal complications (n = 44), graft-versus-host disease (GVHD) (n = 38), and other reasons (n = 29) accounted for 28%, 26%, 18%, 16%, and 12% of readmissions, respectively. During their index admission, patients who were subsequently readmitted had more documented infections (P < .001), higher hematopoietic cell transplantation comorbidity index (HCT-CI) (P < .01), total body irridiation (TBI)-based conditioning (P < .001), unrelated donor (P < .001), and peripheral stem cell (P = .014) transplantation. In multivariable analysis, HCT-CI (odds ratio [OR] = 1.78; 95% confidence interval [CI], 1.25-2.52), TBI-based preparative regimen (OR = 2.63; 95% CI, 1.67-4.13), and infection during admission for allo-HSCT (OR = 2.00; 95% CI, 1.37-2.92) predicted 30-day readmission. Thirty-day readmission itself was an independent predictor of all-cause mortality (hazard ratio [HR](Adj) = 1.66; 95% CI, 1.36-2.10). Our data emphasize the importance of a risk-standardized approach to 30-day hospital readmission if it is used as a quality-of-care metric for bone marrow transplantation., (Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
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- 2012
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8. Cytomegalovirus reactivation after matched sibling donor reduced-intensity conditioning allogeneic hematopoietic stem cell transplant correlates with donor killer immunoglobulin-like receptor genotype.
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Sobecks RM, Askar M, Thomas D, Rybicki L, Kalaycio M, Dean R, Avery R, Mossad S, Copelan E, and Bolwell BJ
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- Adult, Aged, Chi-Square Distribution, Cytomegalovirus genetics, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections virology, DNA, Viral blood, Female, Genotype, HLA Antigens genetics, Humans, Kaplan-Meier Estimate, Ligands, Male, Middle Aged, Ohio, Proportional Hazards Models, Risk Assessment, Risk Factors, Time Factors, Transplantation, Homologous, Treatment Outcome, Cytomegalovirus immunology, Cytomegalovirus Infections immunology, Hematopoietic Stem Cell Transplantation adverse effects, Histocompatibility, Receptors, KIR genetics, Tissue Donors, Transplantation Conditioning, Virus Activation
- Abstract
Objectives: Cytomegalovirus reactivation is common after reduced-intensity conditioning allogeneic hematopoietic stem cell transplant. Natural killer and T cells mediate immunity against viruses including cytomegalovirus. The alloreactivity of natural killer cells and some T-cell subsets is mediated through the interaction of their killer immunoglobulin-like receptors with target cell ligands. This study sought to assess whether donor inhibitory or activating killer immunoglobulin-like receptor genotypes may influence post-transplant cytomegalovirus reactivation in transplant recipients., Materials and Methods: We analyzed 64 patients who underwent T-cell replete, matched sibling donor reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation at our institution. Transplant recipients were categorized according to their HLA inhibitory killer immunoglobulin-like receptor ligand groups. Donor killer immunoglobulin-like receptor genotypes were determined and then were assessed for correlations with cytomegalovirus reactivation in transplant recipients., Results: No differences in cytomegalovirus reactivation were observed when comparing those with or without missing inhibitory killer immunoglobulin-like receptor ligands. When considering the number of donor activating killer immunoglobulin-like receptor genes, those with 5 or 6 had less cytomegalovirus reactivation than those with 1 to 4 (19% vs 48%; P = .029). The difference could not be attributed to baseline patient or transplant characteristics. No specific activating killer immunoglobulin-like receptor genotype was found to be associated with cytomegalovirus reactivation., Conclusions: These observations indicate that assessment of donor killer immunoglobulin-like receptor genotype may have important implications for predicting cytomegalovirus reactivation after T-cell replete, matched sibling donor reduced intensity conditioning allogeneic hematopoietic stem cell transplant.
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- 2011
9. Multiple unit umbilical cord blood transplantation with total body irradiation, etoposide and antithymocyte globulin for adult haematological malignancy patients.
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Sobecks RM, Copelan E, Kalaycio M, Askar M, Rybicki L, Serafino S, Serafin M, Macklis R, Dean R, Pohlman B, Andresen S, and Bolwell BJ
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- Adolescent, Adult, Antilymphocyte Serum therapeutic use, Etoposide therapeutic use, Female, Histocompatibility, Humans, Male, Middle Aged, Treatment Outcome, Whole-Body Irradiation, Young Adult, Cord Blood Stem Cell Transplantation methods, Hematologic Neoplasms therapy, Transplantation Conditioning methods
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- 2011
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10. Obesity does not preclude safe and effective myeloablative hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) in adults.
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Navarro WH, Agovi MA, Logan BR, Ballen K, Bolwell BJ, Frangoul H, Gupta V, Hahn T, Ho VT, Juckett M, Lazarus HM, Litzow MR, Liesveld JL, Moreb JS, Marks DI, McCarthy PL, Pasquini MC, and Rizzo JD
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Comorbidity, Disease-Free Survival, Female, Graft vs Host Disease epidemiology, Humans, Kaplan-Meier Estimate, Leukemia, Myeloid epidemiology, Male, Middle Aged, Myeloablative Agonists adverse effects, Myeloablative Agonists therapeutic use, Overweight epidemiology, Prognosis, Retrospective Studies, Thinness epidemiology, Transplantation, Homologous, Treatment Outcome, Young Adult, Bone Marrow Transplantation statistics & numerical data, Hematopoietic Stem Cell Transplantation statistics & numerical data, Leukemia, Myeloid surgery, Obesity epidemiology, Transplantation Conditioning adverse effects
- Abstract
The incidence of excessive adiposity is increasing worldwide, and is associated with numerous adverse health outcomes. We compared outcomes by body mass index (BMI) for adult patients with acute myelogenous leukemia (AML) who underwent autologous (auto, n = 373), related donor (RD, n = 2041), or unrelated donor (URD, n = 1801) allogeneic myeloablative hematopoietic cell transplantation (HCT) using bone marrow or peripheral blood stem cells reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2004. Four weight groups by BMI (kg/m(2)) were defined: underweight <18 kg/m(2); normal 18-25 kg/m(2); overweight >25-30 kg/m(2); and obese >30 kg/m(2). Multivariable analysis referenced to the normal weight group showed an increased risk of death for underweight patients in the RD group (relative risk [RR], 1.92; 95% confidence interval [CI], 1.28-2.89; P = .002), but not in the URD group. There were no other differences in outcomes among the other weight groups within the other HCT groups. Overweight and obese patients enjoyed a modest decrease in relapse incidence, although this did not translate into a survival benefit. Small numbers of patients limit the ability to better characterize the adverse outcomes seen in the underweight RD but not the underweight URD allogeneic HCT patients. Obesity alone should not be considered a barrier to HCT., (Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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11. Superior survival after replacing oral with intravenous busulfan in autologous stem cell transplantation for non-Hodgkin lymphoma with busulfan, cyclophosphamide and etoposide.
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Dean RM, Pohlman B, Sweetenham JW, Sobecks RM, Kalaycio ME, Smith SD, Copelan EA, Andresen S, Rybicki LA, Curtis J, and Bolwell BJ
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- Administration, Oral, Adolescent, Adult, Aged, Antineoplastic Agents, Alkylating therapeutic use, Antineoplastic Agents, Phytogenic therapeutic use, Cyclophosphamide therapeutic use, Disease-Free Survival, Etoposide therapeutic use, Female, Humans, Injections, Intravenous, Lymphoma, Non-Hodgkin mortality, Male, Middle Aged, Recurrence, Survival Analysis, Transplantation, Autologous, Young Adult, Busulfan administration & dosage, Hematopoietic Stem Cell Transplantation methods, Lymphoma, Non-Hodgkin therapy, Myeloablative Agonists administration & dosage, Transplantation Conditioning methods
- Abstract
Autologous stem cell transplantation (ASCT) with cyclophosphamide, etoposide and oral busulfan (BuCyVP) is an effective therapy for relapsed or refractory non-Hodgkin lymphoma (NHL). Substituting intravenous for oral busulfan reduces variability in drug exposure, potentially improving the safety and efficacy of the BuCyVP regimen. We retrospectively compared the outcomes of 604 consecutively treated patients who underwent ASCT for NHL with BuCyVP using oral (n = 468) or IV (n = 136) busulfan, without measurement of busulfan levels for pharmacokinetic (PK) analysis. Patients who received oral busulfan experienced more severe oral mucositis and a higher incidence of nonrelapse mortality. Median overall survival (OS) after ASCT was 72 months with oral busulfan but was not reached for the IV busulfan group. IV busulfan was associated with a lower rate of relapse, and superior relapse-free survival (RFS) and OS. In multivariate models, the route of busulfan administration was an independent prognostic factor for relapse (P = 0.01), RFS (P = 0.002) and OS (P = 0.001). IV busulfan appears to provide better efficacy and lower toxicity than oral busulfan in ASCT with BuCyVP for NHL. Whether PK-based busulfan dosing can achieve further improvements in this setting is worthy of study.
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- 2010
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12. Allogeneic transplants in follicular lymphoma: higher risk of disease progression after reduced-intensity compared to myeloablative conditioning.
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Hari P, Carreras J, Zhang MJ, Gale RP, Bolwell BJ, Bredeson CN, Burns LJ, Cairo MS, Freytes CO, Goldstein SC, Hale GA, Inwards DJ, Lemaistre CF, Maharaj D, Marks DI, Schouten HC, Slavin S, Vose JM, Lazarus HM, and van Besien K
- Subjects
- Antineoplastic Agents therapeutic use, Data Collection, Disease Progression, Histocompatibility Testing, Humans, Karnofsky Performance Status, Risk, Siblings, Survival Analysis, Transplantation Conditioning mortality, Transplantation Conditioning standards, Transplantation, Homologous, Whole-Body Irradiation, Hematopoietic Stem Cell Transplantation methods, Lymphoma, Follicular therapy, Transplantation Conditioning methods
- Abstract
Reduced-intensity conditioning (RIC) regimens have been increasingly used for allogeneic hematopoietic stem cell transplantation (HSCT) in follicular lymphoma (FL). We compared traditional myeloablative conditioning regimens to RIC in FL. Outcomes of HLA-identical sibling HSCT for FL in 208 recipients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 1997 and 2002 were studied. Conditioning regimens were categorized as myeloablative (N = 120) or RIC (N = 88). Use of RIC regimens increased from <10% of transplants in 1997 to >80% in 2002 signaling a major shift in practice. Patients receiving RIC were older and had a longer interval from diagnosis to transplant. These differences did not correlate with outcomes. Median follow-up of survivors was 50 months (4-96 months) after myeloablative conditioning versus 35 months (4-82 months) after RIC (P < .001). At 3 years, overall survival (OS) for the myeloablative and RIC cohorts were 71 (63%-79%) and 62 (51%-72%; P = .15) and progression free survival (PFS), 67 (58%-75%) and 55 (44%-65%; P = .07), respectively. Lower Karnofsky performance score (KPS) and resistance to chemotherapy were associated with higher treatment-related mortality (TRM) and lower OS and PFS. On multivariate analysis, an increased risk of lymphoma progression after RIC was observed (relative risk = 2.97, P = .04). RIC has become the de facto standard in allogeneic HSCT for FL, and appears to result in similar long-term outcomes. Although disease-free survival (DPS) is similar compared to myeloablative conditioning, an increased risk of late disease progression after RIC is concerning.
- Published
- 2008
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13. The value of augmented preparative regimens combined with an autologous bone marrow transplant for the management of relapsed or refractory Hodgkin disease: a Southwest Oncology Group phase II trial.
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Stiff PJ, Unger JM, Forman SJ, McCall AR, LeBlanc M, Nademanee AP, Bolwell BJ, and Fisher RI
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- Adolescent, Adult, Bone Marrow Transplantation adverse effects, Bone Marrow Transplantation mortality, Carmustine administration & dosage, Combined Modality Therapy, Cyclophosphamide administration & dosage, Disease Management, Etoposide administration & dosage, Female, Hodgkin Disease complications, Hodgkin Disease mortality, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, Survival Analysis, Transplantation Conditioning adverse effects, Transplantation Conditioning mortality, Transplantation, Autologous, Whole-Body Irradiation, Bone Marrow Transplantation methods, Hodgkin Disease therapy, Salvage Therapy methods, Transplantation Conditioning methods
- Abstract
Several single-institution pilot studies have suggested that augmented preparative regimens, including those containing total body irradiation combined with an autologous bone marrow transplantation, are superior to standard regimens for the treatment of relapsed or refractory Hodgkin disease. On the basis of these data, we undertook, in the cooperative group setting, a phase II trial of augmented preparative regimens for patients experiencing treatment failure with conventional chemotherapy. Eighty-one patients with either sensitive or refractory (induction failures or chemoresistant) relapse received etoposide (60 mg/kg), cyclophosphamide (100 mg/kg), and either total body irradiation (12 Gy) or, if previously irradiated, carmustine (15 mg/kg), followed by an autologous bone marrow transplantation. Progression-free (PFS) and overall (OS) survival were estimated, and a Cox regression model was used to assess potential prognostic variables. The 5-year PFS and OS for the 74 eligible patients treated at 20 Southwest Oncology Group centers were 41% (95% confidence interval [CI], 29%-53%) and 54% (95% CI, 43%-65%), respectively, despite a median remission after initial chemotherapy of only 6 months. The 3-year OS for those whose induction therapy failed was 72% (95% CI, 52%-93%). There was 1 (1.4%) early treatment-related death, 2 late deaths due to lung toxicity, and only 1 death due to myelodysplasia. There were no differences in PFS or OS on the basis of regimen or chemosensitivity. A Cox prognostic factor analysis determined that >2 prior regimens, relapse in a radiated field, and extranodal disease were adverse prognostic factors. Among the 46 patients who received prior radiotherapy, the 5-year OS was 38% (95% CI, 14%-61%) for patients with 2 or 3 adverse factors, versus 60% (95% CI, 42%-78%) for those with 0 factors or 1 adverse factor. Augmented preparative regimens seem promising for the treatment of relapsed or refractory Hodgkin disease, without an increase in regimen-related mortality. A poor-prognosis group was identified that should be treated with novel therapies.
- Published
- 2003
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14. Comparison of outcome following allogeneic bone marrow transplantation with cyclophosphamide-total body irradiation versus busulphan-cyclophosphamide conditioning regimens for acute myelogenous leukaemia in first remission.
- Author
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Litzow MR, Pérez WS, Klein JP, Bolwell BJ, Camitta B, Copelan EA, Gale RP, Giralt SA, Keating A, Lazarus HM, Marks DI, McCarthy PL, Miller CB, Milone G, Prentice HG, Russell JA, Schultz KR, Trigg ME, Weisdorf DJ, and Horowitz MM
- Subjects
- Adult, Analysis of Variance, Busulfan administration & dosage, Combined Modality Therapy, Cyclophosphamide administration & dosage, Cyclophosphamide therapeutic use, Disease-Free Survival, Female, Follow-Up Studies, Humans, Male, Middle Aged, Proportional Hazards Models, Recurrence, Registries, Retrospective Studies, Survival Rate, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bone Marrow Transplantation, Leukemia, Myeloid, Acute therapy, Transplantation Conditioning methods, Whole-Body Irradiation
- Abstract
We evaluated transplant-related mortality (TRM), leukaemia relapse, leukaemia-free survival (LFS) and overall survival (OS) in patients receiving busulphan and cyclophosphamide (BuCy) or cyclophosphamide and total body irradiation (CyTBI) prior to allogeneic bone marrow transplantation (BMT) for acute myelogenous leukaemia (AML) in first remission. Outcomes of 381 human leucocyte antigen (HLA)-matched sibling transplants using BuCy were compared with 200 transplants using CyTBI performed between 1988 and 1996. The incidence of hepatic veno-occlusive disease was higher with BuCy (13%) than with CyTBI (6%) (P = 0.009). Risks of acute and chronic GVHD were similar. In multivariate analysis, relapse risk was higher in the BuCy group [relative risk (RR) = 1.72; 95% confidence interval (CI), 1.05-2.81; P = 0.031]. Eleven of 373 evaluable patients in the BuCy group had a central nervous system relapse in contrast to none of 194 evaluable patients in the CyTBI group (P = 0.016). There were no differences in TRM, LFS and OS. CyTBI conditioning may lower relapse risk but produces comparable TRM, LFS and OS to BuCy for HLA-matched sibling transplantation in first remission AML.
- Published
- 2002
- Full Text
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