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High-dose cyclophosphamide, etoposide and BCNU (CVB) with autologous stem cell rescue in malignant lymphomas
- Source :
- European Journal of Haematology. 51:18-24
- Publication Year :
- 2009
- Publisher :
- Wiley, 2009.
-
Abstract
- Eighteen patients with malignant lymphoma, 10 non-Hodgkin's and 8 Hodgkin's, were treated with high-dose CVB (cyclophosphamide 4 x 1.5 g/m2, etoposide 4 x 250-400 mg/m2, carmustine 4 x 150-200 mg/m2), followed by autologous peripheral blood stem cells (PBSC, 13 patients) or bone marrow (BM, 5 patients) transplantation. At the time of autograft 6 patients were in complete remission (CR), 3 in partial remission (PR) and 5 in relapse (4 sensitive, 1 resistant), whereas 4 had progressive disease. All CR patients had poor prognostic features at presentation. PBSC were collected at the time of rapid hematologic recovery after intense chemotherapy by means of a cell separator. All patients engrafted. Median time to achieve > or = 0.5 x 10(9)/l polymorphonuclear cells (PMN) and > or = 50 x 10(9)/l platelets was 13 days for both cell types in PBSC autografted patients, versus 20 and 28 days respectively in BM autografted patients. A significant advantage of PBSC over BM was found in terms of time needed to recover either PMN > or = 0.5 and PMN > or = 1 x 10(9)/l (p = 0.01). Autograft-related toxicity consisted mainly of moderate severity interstitial pneumopathy (3 patients), and veno-occlusive disease (1 patient) that resolved completely. Of the 12 patients autografted with detectable disease, 6 (50%) obtained a CR. Seven out of 18 autografted patients (39%) had disease progression within 1 to 5 months of autograft. The projected progression-free survival is over 50% at 4 years and it was significantly longer in patients with sensitive disease than in those with resistant disease (p = 0.01). The efficacy and the low toxicity of CVB suggest that autograft with PBSC may be proposed for the primary treatment of poor prognosis malignant lymphomas.
- Subjects :
- Adult
Male
medicine.medical_specialty
Pathology
Time Factors
Lymphoma
Cyclophosphamide
medicine.medical_treatment
Transplantation, Autologous
Gastroenterology
Colony-Forming Units Assay
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Autologous transplantation
Etoposide
Bone Marrow Transplantation
Neoplasm Staging
Salvage Therapy
Carmustine
Chemotherapy
business.industry
Lymphoma, Non-Hodgkin
Hematology
General Medicine
Middle Aged
medicine.disease
Combined Modality Therapy
Hodgkin Disease
Transplantation
medicine.anatomical_structure
Female
Bone marrow
business
Progressive disease
Follow-Up Studies
Stem Cell Transplantation
medicine.drug
Subjects
Details
- ISSN :
- 16000609 and 09024441
- Volume :
- 51
- Database :
- OpenAIRE
- Journal :
- European Journal of Haematology
- Accession number :
- edsair.doi.dedup.....881f34ff7f5f0d15acc02002b2c0ae30