TORNA ALL’ELENCO

Factors influencing the occurrence of secondary myelodysplastic syndrome/acute leukemia following high-dose therapy and autograft: A GITIL (Gruppo Italiano Terapie innovative nei linfomi) survey in 1,347 lymphoma patients in Haematologica

2009
AO Ordine Mauriziano
AOU San Luigi di Orbassano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (21)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 sMDS/AL 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. All patients received either the original or modified HDS regimens; PBPC were usually collected after hd-cyclophosphamide, or, 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. Most patients were autografted with PBPC (median CD34+ cells: 8×106/kg), few received BM cells; a 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. Overall, 53 (3.9%) patients developed s-MDS/AL, with a cumulative incidence of sMDS/AL of 3.1% at 5 yrs and 4.6% at 10 yrs. Median time of s-MDS/AL occurrence was 3.2 yrs since autograft. In univariate analysis, age >45 yrs., male sex and autograft with PBPC of the 2nd mobilization round had a significantly higher risk of sMDS/AL; a trend for a higher incidence was observed in patients receiving HDS with Rituximab (p=0.092) and in those presenting with BM involvement (p=0.075); on multivariate analysis, age >45 yrs. and auto

Keywords

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