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Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2015 Jun; Vol. 21 (6), pp. 1046-1053. Date of Electronic Publication: 2015 Feb 14. - Publication Year :
- 2015
-
Abstract
- There are limited data to guide the choice of high-dose therapy (HDT) regimen before autologous hematopoietic cell transplantation (AHCT) for patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). We studied 4917 patients (NHL, n = 3905; HL, n = 1012) who underwent AHCT from 1995 to 2008 using the most common HDT platforms: carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) (n = 1730); cyclophosphamide, BCNU, and etoposide (CBV) (n = 1853); busulfan and cyclophosphamide (BuCy) (n = 789); and total body irradiation (TBI)-containing treatment (n = 545). CBV was divided into CBV(high) and CBV(low) based on BCNU dose. We analyzed the impact of regimen on development of idiopathic pulmonary syndrome (IPS), transplantation-related mortality (TRM), and progression-free and overall survival. The 1-year incidence of IPS was 3% to 6% and was highest in recipients of CBV(high) (hazard ratio [HR], 1.9) and TBI (HR, 2.0) compared with BEAM. One-year TRM was 4% to 8%, respectively, and was similar between regimens. Among patients with NHL, there was a significant interaction between histology, HDT regimen, and outcome. Compared with BEAM, CBV(low) (HR, .63) was associated with lower mortality in follicular lymphoma (P < .001), and CBV(high) (HR, 1.44) was associated with higher mortality in diffuse large B cell lymphoma (P = .001). For patients with HL, CBV(high) (HR, 1.54), CBV(low) (HR, 1.53), BuCy (HR, 1.77), and TBI (HR, 3.39) were associated with higher mortality compared with BEAM (P < .001). The impact of specific AHCT regimen on post-transplantation survival is different depending on histology; therefore, further studies are required to define the best regimen for specific diseases.<br /> (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Busulfan therapeutic use
Carmustine therapeutic use
Cyclophosphamide therapeutic use
Cytarabine therapeutic use
Drug Administration Schedule
Etoposide therapeutic use
Female
Hodgkin Disease immunology
Hodgkin Disease mortality
Hodgkin Disease pathology
Humans
Lymphoma, Non-Hodgkin immunology
Lymphoma, Non-Hodgkin mortality
Lymphoma, Non-Hodgkin pathology
Male
Melphalan therapeutic use
Middle Aged
Retrospective Studies
Survival Analysis
Transplantation, Autologous
Whole-Body Irradiation
Hematopoietic Stem Cell Transplantation
Hodgkin Disease therapy
Lymphoma, Non-Hodgkin therapy
Myeloablative Agonists therapeutic use
Registries
Transplantation Conditioning methods
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 21
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 25687795
- Full Text :
- https://doi.org/10.1016/j.bbmt.2015.02.005