DexaBEAM versus ICE salvage regimen prior to autologous transplantation for relapsed or refractory aggressive peripheral T cell lymphoma: a retrospective evaluation of parallel patient cohorts of one center

Autor: Rolf M. Mesters, Angela Demant, Nils H. Thoennissen, Mareike Kuhlmann, Wolfgang E. Berdel, Carsten Müller-Tidow, Jan-Henrik Mikesch, Gabriela B. Thoennissen, Michael Mohr, Christoph Schliemann, Eva Schmidt, Georg Evers, Torsten Kessler, Michele Pohlen, Gabriele Köhler, Utz Krug, Johannes Wessling
Rok vydání: 2012
Předmět:
Melphalan
Adult
Male
Mucositis
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Salvage therapy
Kaplan-Meier Estimate
Transplantation
Autologous
Dexamethasone
Disease-Free Survival
Carboplatin
Young Adult
Autologous stem-cell transplantation
Antineoplastic Combined Chemotherapy Protocols
Granulocyte Colony-Stimulating Factor
Preoperative Care
medicine
Autologous transplantation
Humans
Ifosfamide
Etoposide
Aged
Retrospective Studies
Salvage Therapy
Chemotherapy
Peripheral Blood Stem Cell Transplantation
business.industry
Cytarabine
Lymphoma
T-Cell
Peripheral
Hematology
General Medicine
Middle Aged
Carmustine
Combined Modality Therapy
Hematologic Diseases
Hematopoietic Stem Cell Mobilization
Surgery
Transplantation
Regimen
Treatment Outcome
Drug Evaluation
Female
business
medicine.drug
Zdroj: Annals of hematology. 92(8)
ISSN: 1432-0584
Popis: High-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) is considered standard in the treatment of patients with relapsed or refractory aggressive peripheral T cell lymphoma (PTCL). However, the optimal salvage regimen before ASCT has not yet been established. We retrospectively analyzed 31 patients with relapsed or refractory aggressive PTCL after anthracycline-based first-line chemotherapy who received either DexaBEAM (dexamethasone, carmustine, etoposide, cytarabine, and melphalan; n = 16) or ICE (ifosfamide, carboplatin, and etoposide; n = 15) regimen as first salvage chemotherapy followed by HDT/ASCT. The overall response rate (OR) was significantly higher for patients treated with DexaBEAM (69 %; 95 % confidence interval 46.0–91.5 %) as compared to the ICE group (20 %; 95 % confidence interval −0.2–40.2 %; P = 0.01), with higher complete response (CR; 38 %; 95 % confidence interval 13.8–61.2 %; vs. 7 %; 95 % confidence interval −6.0–19.6 %) as well as partial response (PR; 31 vs. 13 %) rate. Changing regimen due to failure of first salvage therapy, 12 patients initially receiving ICE still achieved an OR of 58 % (33 % CR, 25 % PR) with DexaBEAM as second salvage therapy, whereas in three patients receiving ICE after DexaBEAM failure, only one achieved an OR (1 PR). Median progression-free survival was significantly higher in the DexaBEAM group (6.4 vs. 2 months; P = 0.01). Major adverse event in both groups was myelosuppression with higher but tolerable treatment-related toxicity for patients in the DexaBEAM group. For all patients proceeding to HDT/ASCT, a 3-year overall survival was 50 %. Together, considering the limitations of the retrospective design of the evaluation and the small sample size, our data suggest that DexaBEAM salvage chemotherapy is superior to ICE for patients with relapsed or refractory aggressive PTCL for remission induction prior to autologous transplantation, with higher but manageable treatment-related toxicity.
Databáze: OpenAIRE
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