TORNA ALL’ELENCO

Male gender, quality of grafted cells, advanced age, rituximab and radiotherapy are the main factors that variously influence the occurrence of secondary malignancies following high-dose therapy and autograft: A GITIL (Gruppo Italiano Terapie Innovative nei Linfomi) survey in 1,347 lymphoma patients in Blood

2009
AO Ordine Mauriziano
AOU San Luigi di Orbassano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (22)Vedi tutti...

Tarella C

Passera R

Magni M


et alii...

Abstract

Introduction: High-dose (hd) therapy with stem cell autograft is an effective treatment for both non-Hodgkin's (NHL) and Hodgkin's Lymphoma (HL). However, the occurrence of secondary malignancies, particularly myelodysplastic syndromes/acute leukemias (sMDS/AL), is a critical issue, representing a major cause of failure in patients potentially cured after hd-chemotherapy. Aim of the study: To evaluate: frequency-cumulative incidence-risk factors, of both sMDS/AL and solid tumors in a large series of lymphoma patients, treated with the hd-sequential (HDS) chemotherapy approach, followed by peripheral blood progenitor cell (PBPC) autograft. Patients and Methods: Data have been collected on 1,347 lymphoma patients treated in the last two decades at 11 Centers, associated to GITIL. Patients received either the original or modified HDS regimens; PBPC were collected after hd-cyclophosphamide, and, in a subgroup, after a 2nd round of mobilization with hd-Ara-C. The series included 1,024 B-cell NHL, 234 HL and 89 T-cell NHL; there were 695 high-grade, 278 low-grade and 140 mantle-cell lymphoma; median age was 46 yrs; 57% were male. Overall, 640 (47%) patients received HDS front-line. Autograft was usually performed with PBPC (median CD34+ cells: 7×106/kg); most patients (n=774) received PBPC collected at the 1st mobilization course, whereas some others (n=298) were autografted with PBPC collected following a 2nd high-dose course. The Mitoxantrone/L-PAM combination was the most frequently employed conditioning for autograft (n=643), followed by BEAM (n=301); TBI-conditioning regimen was employed only in 79 patients. Results: At a median follow-up of 7 yrs, the 5 and 10 yr Overall Survival (OS) projections are 64% and 56%, respectively. Among B-cell NHL, 70.5% of patients treated with Rituximab-supplemented HDS are presently alive vs. 55.6 of those treated with Rituximab-free HDS (p=0.001). Overall, 54 (4.0%) patients developed s-MDS/AL, with a cumulative incidence of

Keywords

B lymphocyte; chemotherapy; multivariate analysis; univariate analysis; overall survival; conditioning; risk factor; risk; mobilization; solid malignant neoplasm; society; hematology; gender; therapy; drug megadose; radiotherapy; male; lymphoma; autograft; patient; cytarabine; cyclophosphamide; rituximab; stem cell; leukemia; peripheral blood stem cell; T lymphocyte; mantle cell lymphoma; follow up; diagnosis; Hodgkin disease;