Allogeneic transplantation for recurrent or refractory non-Hodgkin's lymphoma with poor prognostic features after conditioning with thiotepa, busulfan, and cyclophosphamide: Experience in 44 consecutive patients

Koen Van Besien, Peter Thall, Martin Korbling, William C. Pugh, Issa Khouri, Rakesh Mehra, Sergio Giralt, Paolo Anderlini, Kamal Amin, Nadeem Mirza, David Seong, James Gajewski, Jeane Hester, Borje Andersson, Fernando Cabanillas, Richard Champlin, Donna Przepiorka

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

We report the outcomes of 44 consecutive patients with non-Hodgkin's lymphoma (NHL) who participated in prospective studies of allogeneic transplantation after conditioning with thiotepa, busulfan and cyclophosphamide. Within a range of 27-57 years, the median age was 37. Of the 44 patients, 12 (27.2%) had high-grade lymphomas, 27 (61.4%) had intermediate-grade lymphomas, and five (11.3%) had low-grade lymphomas. Twenty-eight (63.6%) patients had chemotherapy refractory disease. Thirty (68.2%) patients had stage IV disease at the time of transplantation, involving the bone marrow in 19 (43.2%). Eight (18.1%) patients had undergone a previous transplantation, and 13 (29.5%) patients had received high-dose CVP as induction within 2 months prior to transplantation. Thirty-eight (86.3%) patients had an HLA-identical donor, and 6 (13.6%) had a one-antigen mismatched related donor. Twenty (45.4%) patients received bone marrow and 24 (54.6%) received granulocyte colony-stimulating factor (G-CSF) mobilized stem cells. The graft-versus-host disease (GVHD) prophylaxis contained cyclosporine or tacrolimus in combination with either methylprednisolone in 32 (72.7%) patients or with methotrexate in 12 (27.2%) patients. The actuarial probability of disease-free survival at 2 years is 23% (95% CI 13%-40%). Donor stem cell use was associated with a significantly decreased risk of treatment-related toxicity (p <0.001), but with an increased risk for GVHD and delayed fungal and viral infections. These infections are linked not only to the use of donor-stem cells, but also to the methylprednisolone in the GVHD prophylaxis regimen. Improvements in the outcome of patients with advanced NHL and undergoing allogeneic transplantation will depend on the development of effective and non-toxic regimens for conditioning, GVHD prophylaxis, and opportunistic infections prophylaxis.

Original languageEnglish (US)
Pages (from-to)150-156
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume3
Issue number3
StatePublished - Aug 1997
Externally publishedYes

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Thiotepa
Busulfan
Homologous Transplantation
Non-Hodgkin's Lymphoma
Cyclophosphamide
Graft vs Host Disease
Tissue Donors
Stem Cells
Methylprednisolone
Transplantation Conditioning
Transplantation
Mycoses
Opportunistic Infections
Tacrolimus
Granulocyte Colony-Stimulating Factor
Virus Diseases
Bone Marrow Transplantation
Methotrexate
Cyclosporine
Disease-Free Survival

Keywords

  • Allogeneic transplantation
  • Blood stem cells
  • Lymphoma

ASJC Scopus subject areas

  • Transplantation

Cite this

Allogeneic transplantation for recurrent or refractory non-Hodgkin's lymphoma with poor prognostic features after conditioning with thiotepa, busulfan, and cyclophosphamide : Experience in 44 consecutive patients. / Van Besien, Koen; Thall, Peter; Korbling, Martin; Pugh, William C.; Khouri, Issa; Mehra, Rakesh; Giralt, Sergio; Anderlini, Paolo; Amin, Kamal; Mirza, Nadeem; Seong, David; Gajewski, James; Hester, Jeane; Andersson, Borje; Cabanillas, Fernando; Champlin, Richard; Przepiorka, Donna.

In: Biology of Blood and Marrow Transplantation, Vol. 3, No. 3, 08.1997, p. 150-156.

Research output: Contribution to journalArticle

Van Besien, K, Thall, P, Korbling, M, Pugh, WC, Khouri, I, Mehra, R, Giralt, S, Anderlini, P, Amin, K, Mirza, N, Seong, D, Gajewski, J, Hester, J, Andersson, B, Cabanillas, F, Champlin, R & Przepiorka, D 1997, 'Allogeneic transplantation for recurrent or refractory non-Hodgkin's lymphoma with poor prognostic features after conditioning with thiotepa, busulfan, and cyclophosphamide: Experience in 44 consecutive patients', Biology of Blood and Marrow Transplantation, vol. 3, no. 3, pp. 150-156.
Van Besien, Koen ; Thall, Peter ; Korbling, Martin ; Pugh, William C. ; Khouri, Issa ; Mehra, Rakesh ; Giralt, Sergio ; Anderlini, Paolo ; Amin, Kamal ; Mirza, Nadeem ; Seong, David ; Gajewski, James ; Hester, Jeane ; Andersson, Borje ; Cabanillas, Fernando ; Champlin, Richard ; Przepiorka, Donna. / Allogeneic transplantation for recurrent or refractory non-Hodgkin's lymphoma with poor prognostic features after conditioning with thiotepa, busulfan, and cyclophosphamide : Experience in 44 consecutive patients. In: Biology of Blood and Marrow Transplantation. 1997 ; Vol. 3, No. 3. pp. 150-156.
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abstract = "We report the outcomes of 44 consecutive patients with non-Hodgkin's lymphoma (NHL) who participated in prospective studies of allogeneic transplantation after conditioning with thiotepa, busulfan and cyclophosphamide. Within a range of 27-57 years, the median age was 37. Of the 44 patients, 12 (27.2{\%}) had high-grade lymphomas, 27 (61.4{\%}) had intermediate-grade lymphomas, and five (11.3{\%}) had low-grade lymphomas. Twenty-eight (63.6{\%}) patients had chemotherapy refractory disease. Thirty (68.2{\%}) patients had stage IV disease at the time of transplantation, involving the bone marrow in 19 (43.2{\%}). Eight (18.1{\%}) patients had undergone a previous transplantation, and 13 (29.5{\%}) patients had received high-dose CVP as induction within 2 months prior to transplantation. Thirty-eight (86.3{\%}) patients had an HLA-identical donor, and 6 (13.6{\%}) had a one-antigen mismatched related donor. Twenty (45.4{\%}) patients received bone marrow and 24 (54.6{\%}) received granulocyte colony-stimulating factor (G-CSF) mobilized stem cells. The graft-versus-host disease (GVHD) prophylaxis contained cyclosporine or tacrolimus in combination with either methylprednisolone in 32 (72.7{\%}) patients or with methotrexate in 12 (27.2{\%}) patients. The actuarial probability of disease-free survival at 2 years is 23{\%} (95{\%} CI 13{\%}-40{\%}). Donor stem cell use was associated with a significantly decreased risk of treatment-related toxicity (p <0.001), but with an increased risk for GVHD and delayed fungal and viral infections. These infections are linked not only to the use of donor-stem cells, but also to the methylprednisolone in the GVHD prophylaxis regimen. Improvements in the outcome of patients with advanced NHL and undergoing allogeneic transplantation will depend on the development of effective and non-toxic regimens for conditioning, GVHD prophylaxis, and opportunistic infections prophylaxis.",
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AU - Van Besien, Koen

AU - Thall, Peter

AU - Korbling, Martin

AU - Pugh, William C.

AU - Khouri, Issa

AU - Mehra, Rakesh

AU - Giralt, Sergio

AU - Anderlini, Paolo

AU - Amin, Kamal

AU - Mirza, Nadeem

AU - Seong, David

AU - Gajewski, James

AU - Hester, Jeane

AU - Andersson, Borje

AU - Cabanillas, Fernando

AU - Champlin, Richard

AU - Przepiorka, Donna

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N2 - We report the outcomes of 44 consecutive patients with non-Hodgkin's lymphoma (NHL) who participated in prospective studies of allogeneic transplantation after conditioning with thiotepa, busulfan and cyclophosphamide. Within a range of 27-57 years, the median age was 37. Of the 44 patients, 12 (27.2%) had high-grade lymphomas, 27 (61.4%) had intermediate-grade lymphomas, and five (11.3%) had low-grade lymphomas. Twenty-eight (63.6%) patients had chemotherapy refractory disease. Thirty (68.2%) patients had stage IV disease at the time of transplantation, involving the bone marrow in 19 (43.2%). Eight (18.1%) patients had undergone a previous transplantation, and 13 (29.5%) patients had received high-dose CVP as induction within 2 months prior to transplantation. Thirty-eight (86.3%) patients had an HLA-identical donor, and 6 (13.6%) had a one-antigen mismatched related donor. Twenty (45.4%) patients received bone marrow and 24 (54.6%) received granulocyte colony-stimulating factor (G-CSF) mobilized stem cells. The graft-versus-host disease (GVHD) prophylaxis contained cyclosporine or tacrolimus in combination with either methylprednisolone in 32 (72.7%) patients or with methotrexate in 12 (27.2%) patients. The actuarial probability of disease-free survival at 2 years is 23% (95% CI 13%-40%). Donor stem cell use was associated with a significantly decreased risk of treatment-related toxicity (p <0.001), but with an increased risk for GVHD and delayed fungal and viral infections. These infections are linked not only to the use of donor-stem cells, but also to the methylprednisolone in the GVHD prophylaxis regimen. Improvements in the outcome of patients with advanced NHL and undergoing allogeneic transplantation will depend on the development of effective and non-toxic regimens for conditioning, GVHD prophylaxis, and opportunistic infections prophylaxis.

AB - We report the outcomes of 44 consecutive patients with non-Hodgkin's lymphoma (NHL) who participated in prospective studies of allogeneic transplantation after conditioning with thiotepa, busulfan and cyclophosphamide. Within a range of 27-57 years, the median age was 37. Of the 44 patients, 12 (27.2%) had high-grade lymphomas, 27 (61.4%) had intermediate-grade lymphomas, and five (11.3%) had low-grade lymphomas. Twenty-eight (63.6%) patients had chemotherapy refractory disease. Thirty (68.2%) patients had stage IV disease at the time of transplantation, involving the bone marrow in 19 (43.2%). Eight (18.1%) patients had undergone a previous transplantation, and 13 (29.5%) patients had received high-dose CVP as induction within 2 months prior to transplantation. Thirty-eight (86.3%) patients had an HLA-identical donor, and 6 (13.6%) had a one-antigen mismatched related donor. Twenty (45.4%) patients received bone marrow and 24 (54.6%) received granulocyte colony-stimulating factor (G-CSF) mobilized stem cells. The graft-versus-host disease (GVHD) prophylaxis contained cyclosporine or tacrolimus in combination with either methylprednisolone in 32 (72.7%) patients or with methotrexate in 12 (27.2%) patients. The actuarial probability of disease-free survival at 2 years is 23% (95% CI 13%-40%). Donor stem cell use was associated with a significantly decreased risk of treatment-related toxicity (p <0.001), but with an increased risk for GVHD and delayed fungal and viral infections. These infections are linked not only to the use of donor-stem cells, but also to the methylprednisolone in the GVHD prophylaxis regimen. Improvements in the outcome of patients with advanced NHL and undergoing allogeneic transplantation will depend on the development of effective and non-toxic regimens for conditioning, GVHD prophylaxis, and opportunistic infections prophylaxis.

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