High-dose radioimmunotherapy versus conventional high-dose therapy and autologous hematopoietic stem cell transplantation for relapsed follicular non-Hodgkin lymphoma: a multivariable cohort analysis
| Autor: | Irwin D. Bernstein, Oliver W. Press, Frederick R. Appelbaum, David G. Maloney, Joseph G. Rajendran, Paul J. Martin, Janet F. Eary, Lawrence D. Durack, Dana C. Matthews, Stephen H. Petersdorf, Jane Golden, Ajay K. Gopal, Sharon A. Bush, Ted Gooley |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Immunology Follicular lymphoma Hematopoietic stem cell transplantation Biochemistry Gastroenterology Tositumomab Cohort Studies Iodine Radioisotopes Internal medicine Humans Medicine Lymphoma Follicular Chemotherapy business.industry Lymphoma Non-Hodgkin Hazard ratio Hematopoietic Stem Cell Transplantation Dose-Response Relationship Radiation Cell Biology Hematology Middle Aged Radioimmunotherapy Total body irradiation Antigens CD20 medicine.disease Combined Modality Therapy Surgery Survival Rate Radiation therapy Treatment Outcome Multivariate Analysis Disease Progression Female Neoplasm Recurrence Local business medicine.drug |
| Zdroj: | Blood. 102:2351-2357 |
| ISSN: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood-2003-02-0622 |
| Popis: | We performed a multivariable comparison of 125 consecutive patients with follicular lymphoma (FL) treated at our centers with either high-dose radioimmunotherapy (HD-RIT) using 131I-anti-CD20 (n = 27) or conventional high-dose therapy (C-HDT) (n = 98) and autologous hematopoietic stem cell transplantation. The groups were similar, although more patients treated with HD-RIT had an elevated pretransplantation level of lactate dehydrogenase (41% versus 20%, P = .03) and elevated international prognostic score (41% versus 19%, P = .02). Patients treated with HD-RIT received individualized therapeutic doses of 131I-tositumomab (median, 19.7 GBq [531 mCi]) to deliver 17 to 31 Gy (median, 27 Gy) to critical organs. Patients treated with C-HDT received total body irradiation plus chemotherapy (70%) or chemotherapy alone (30%). Patients treated with HD-RIT experienced improved overall survival (OS) (unadjusted hazard ratio [HR] for death = 0.4 [95% confidence interval (95% CI), 0.2-0.9], P = .02; adjusted HR, 0.3, P = .004) and progression-free survival (PFS) (unadjusted HR = .6 [95% C.I., 0.3-1.0], P = .06; adjusted HR, 0.5, P = .03) versus patients treated with C-HDT. The estimated 5-year OS and PFS were 67% and 48%, respectively, for HD-RIT and 53% and 29%, respectively, for C-HDT. One hundred-day treatment-related mortality was 3.7% in the HD-RIT group and 11% in the C-HDT group. The probability of secondary myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) was estimated to be .076 at 8 years in the HD-RIT group and .086 at 7 years in the C-HDT group. HD-RIT may improve outcomes versus C-HDT in patients with relapsed FL. (Blood. 2003;102:2351-2357) |
| Databáze: | OpenAIRE |
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