Non-Hodgkin lymphoma patients responded to high-dose carmustine, etoposide, and cyclophosphamide

09-11-2006

Non-Hodgkin lymphoma (NHL) patients who undergo allogeneic hematopoietic cell transplantation (HCT) could be effectively treated by high-dose carmustine, etoposide, and cyclophosphamide (CBV).

"Allogeneic HCT has been shown to be curative in a group of patients with aggressive NHL. A previous study has demonstrated equivalent outcomes with a conditioning regimen based on total body irradiation and another not based on total body irradiation with preparative therapy using CBV in autologous HCT," scientists in the United States reported.

"We investigated the safety and efficacy of using CBV in an allogeneic setting. Patients were required to have relapsed or be at high risk for subsequent relapse of NHL. All patients had a fully HLA-matched sibling donor. Patients received carmustine (15 mg/kg), etoposide (60 mg/kg), and cyclophosphamide (100 mg/kg) on days -6, -4, and -2, respectively, followed by allogeneic HCT," explained L.Y. Law and colleagues, Stanford University.

"All patients were treated with cyclosporine and methylprednisolone, as prophylaxis for graft-versus-host disease (GVHD). Thirty-one patients (median age, 46 years) who were felt to be inappropriate candidates for autologous transplantation were enrolled. Each subject had a median of 3 previous chemotherapy regimens. All patients engrafted. Fifteen of 31 patients are alive. Median follow-up time was 11.5 months (range, .4-126). There were 8 deaths due to relapse. Nonrelapse mortality (n=8) included infection (n=3), GVHD (n=2), diffuse alveolar hemorrhage (n=1), venoocclusive disease in the setting of concurrent acute GVHD of the liver (n=1), and leukoencephalopathy (n=1).

"Probabilities of event-free survival and overall survival were, respectively, 44% (95% confidence interval, 26%-62%) and 51% (33%-69%) at 1 year and 44% (26%-62%) and 47% (29%-65%) at 5 years. Probability of relapse was 33% (15%-51%) at 1 year and 5 years. Probability of nonrelapse mortality was 31% (13%-49%) at 1 year and 5 years. Incidences were 29% for acute GVHD and 39% for chronic GVHD. None of the 12 patients who developed chronic GVHD has disease recurrence. Patients who had required >3 previous chemotherapy regimens before HCT had an increased probability of relapse," discovered the investigators.

The researchers concluded, "CBV is an effective preparative regimen for patients with aggressive NHL who undergo allogeneic HCT."

Law and colleagues published their study in Biology of Blood and Marrow Transplantation (High-dose carmustine, etoposide, and cyclophosphamide followed by allogeneic hematopoietic cell transplantation for non-Hodgkin lymphoma. Biol Blood Marrow Transplant, 2006;12(7):703-711).

For additional information, contact L.Y. Law, Stanford University, Medical Center, Division Blood & Marrow Transplantation, 300 Pasteur Dr., H3249, Stanford, CA 94305, USA.

The publisher's contact information for the journal Biology of Blood and Marrow Transplantation is: Carden Jennings Publ Co. Ltd., Blake Center, Ste. 200, 1224 W Main St., Charlottesville, VA 22903, USA.

Keywords: Stanford, California, United States, Allogeneic Hematopoietic Cell Transplantation, Etoposide, Carmustine, Chemotherapy, Cyclophosphamide, Cyclosporin, Cancer Drugs, Epidemiology, Graft-Versus-Host Disease, Hematology, Hematopoietic Cells, Methylprednisolone, Non Hodgkin Lymphoma, Oncology, Organ Transplant, Pharmaceuticals, Stem Cell Research, Cancer Therapy.

This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2006, Clinical Oncology Week via NewsRx.com.