Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine‐based high‐dose chemotherapy regimen

Autor: Nicola Di Renzo, Paolo Di Carlo, Domenico Pastore, Nicola Cascavilla, Erminio Bonizzoni, Giuseppe Messina, Anna Mele, R. Matera, Potito Rosario Scalzulli, Chiara Ciochetto, Anxur Merenda, Antonello Pinto, Francesco Lanza, Vincenzo Pavone, Massimo Di Nicola, Maurizio Musso, Umberto Vitolo, Enrico Orciuolo, Stella Santarone, Renato Scalone, Gianpaolo Marcacci, Angelo Michele Carella, Daniela Donnarumma, Tiziana Moscato, Alessandra Crescimanno
Rok vydání: 2015
Předmět:
Male
Oncology
Melphalan
Transplantation Conditioning
autologous stem cell transplantation
medicine.medical_treatment
Salvage therapy
Kaplan-Meier Estimate
Nitrosourea Compounds
0302 clinical medicine
Autologous stem-cell transplantation
Antineoplastic Combined Chemotherapy Protocols
High-dose chemotherapy
Medicine
Prospective Studies
Registries
Child
Etoposide
Haematological Malignancy
Graft Survival
Cytarabine
Hematopoietic Stem Cell Transplantation
Hematology
Middle Aged
fotemustine
Hodgkin Disease
Treatment Outcome
030220 oncology & carcinogenesis
high‐dose chemotherapy
Female
Research Paper
medicine.drug
Adult
medicine.medical_specialty
Adolescent
NO
Young Adult
03 medical and health sciences
Organophosphorus Compounds
Internal medicine
Humans
Aged
Salvage Therapy
Chemotherapy
business.industry
Autologous stem cell transplantation
Fotemustine
Hodgkin lymphoma
Drug Evaluation
Positron-Emission Tomography
Surgery
Regimen
business
030215 immunology
Zdroj: British Journal of Haematology
ISSN: 1365-2141
0007-1048
Popis: High-dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third-generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR-HL accrued into a prospective registry-based study. Application of FEAM resulted in a 2-year progression-free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64-0·81] with median PFS, overall survival and time to progression yet to be reached. The 2-year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12-0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose ((18) (F) FDG)-uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had (18) (F) FDG-positrin emission tomography-positive lesions before HDT, the 2-year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12-0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR-HL patients typically pre-exposed to lung-damaging treatments.
Databáze: OpenAIRE
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