LATE COMPLICATIONS OF CONDITIONING REGIMENS (CYCLOPHOSPHAMIDE - TOTAL BODY IRRADIATION VS. BEAM) FOR AUTOLOGOUS STEM CELL TRANSPLANTATION IN NON-HODGKIN LYMPHOMA.
(Abstract release date: 05/18/17)
EHA Library. Novelli S. 05/18/17; 182872; PB2159
Ms. Silvana Novelli
Contributions
Contributions
Abstract
Abstract: PB2159
Type: Publication Only
Background
Autologous stem cell transplantation (ASCT) is a frequently used procedure for the treatment of patients with relapsed non-Hodgkin lymphoma (NHL). While chemotherapy-based regimens are now commonly administered, total body irradiation (TBI) was largely used in the past. The current conditioning regimen in our center is BEAM (a combination of carmustine (BCNU), etoposide, cytarabine and melphalan) allthough we also have a large experience with cyclophosphamide (CFM)-total body irradiation (TBI) since this was the usual conditioning until year 2000.
Aims
To analyze the cumulative incidence of secondary neoplastic complications and non neoplastic complications (grade 3-4 infections, cardiovascular and pulmonary toxicity) after the two conditioning regimens (CFM-TBI vs. BEAM) for ASCT
Methods
We performed a retrospective analysis of patients with NHL that received an ASCT between October 1992 and December 2012. The late complications were defined as those to other previous comorbidity or to aging. Statistical analysis was performed using the IBM SPSS Statistics version 21.0. Cumulative incidences were estimated using EZR version 1.27 (Saitama Medical Center, Jichi Medical University, Omiya, Japan), a graphical user interface for R (version 3.1.1).
Results
A total of 105 atografted patients were analyzed. Patient’s characteristics are in Table 1. The median follow up since ASCT was 73 months (0 – 274 months). Thirty-one percent (n=33) of patients were conditioned with CFM-TBI. The overall 5-years survival (OS) was 68.3% (58-77% - CI 95%) and the 5-year disease free survival (DFS) was 52% (42 61% - CI 95%). There were no differences regarding OS and DFS between the two conditioning regimens. The 5-years cumulative incidence (CI) of relapse was 0.48 (0.37-0.57, CI 95%). We detected 10 secondary neoplasm (myelodysplasia n=1, skin carcinoma n=2, lung carcinoma n=3, oropharingeal carcinoma n= 1, intestinal adenocarcinoma n=1, renal neoplasia n=1, bladder neoplasia n=1). The median time for the neoplastic event was 10.5 years (0-18.5 years). The CI of secondary neoplasias (2nd neoplasia) at 10 years was 10% (1-20%, CI 95%) and at last point of follow up (18.5 years) was 40% (13%>63%, CI 95%). There were no differences in the CI of 2nd neoplasias between BEAM and CFM-TBI. Non-neoplastic complications were present in 10% of patients (n=11). Three cases were infections grade 3-4 related to ASCT. Six cases had cardiac complications (5 acute coronary syndrome, 1 myocardiopathy) and 2 had pulmonary toxicity. The CI of non-2nd neoplastic complications at 10 year was 10% (1 – 25%, CI 95%).No differences were detected between the two conditioning regimens regarding non-neosplastic complications.(see Figure 1).
Table. 1. Patient’s characteristics | Frequency (n) | Percentage |
Age (years) | 51 years old (18-70 years) | |
Gender | Male: 62 | 59% |
Histology | Diffuse Large Cell Lymphoma: 40 | 38% |
Follicular Lymphoma: 65 | 62% | |
Prognostic Index (IPI or FLIPI) (when available, n=103) | Low risk: 23; Intermediate risk: 67; High risk: 13 | 22%/65%/13% |
Response pre- ASCT | Complete Remission: 58 | 55% |
Partial Remission: 46 | 44% | |
Stable disease: 1 | 1% | |
Number of Lines pre-ASCT | 1 line: 11; 2 lines: 69; 3 lines: 18; 4 lines: 7 | 10%/66%/17%/7% |
Conditioning | CFM-TBI: 33 ; BEAM: 74 | 31% / 69% |
Conclusion
Autologous stem cell transplantation offers long disease free survival for half of the patients with a high risk non-Hodgkin lymphoma. In our series, patients conditioned with BEAM or CFM-TBI had a comparable incidence of neoplastic and non-neoplastic events
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): Late complications and outcome, Follicular lymphoma, Diffuse large B cell lymphoma, Autologous hematopoietic stem cell transplantation
Abstract: PB2159
Type: Publication Only
Background
Autologous stem cell transplantation (ASCT) is a frequently used procedure for the treatment of patients with relapsed non-Hodgkin lymphoma (NHL). While chemotherapy-based regimens are now commonly administered, total body irradiation (TBI) was largely used in the past. The current conditioning regimen in our center is BEAM (a combination of carmustine (BCNU), etoposide, cytarabine and melphalan) allthough we also have a large experience with cyclophosphamide (CFM)-total body irradiation (TBI) since this was the usual conditioning until year 2000.
Aims
To analyze the cumulative incidence of secondary neoplastic complications and non neoplastic complications (grade 3-4 infections, cardiovascular and pulmonary toxicity) after the two conditioning regimens (CFM-TBI vs. BEAM) for ASCT
Methods
We performed a retrospective analysis of patients with NHL that received an ASCT between October 1992 and December 2012. The late complications were defined as those to other previous comorbidity or to aging. Statistical analysis was performed using the IBM SPSS Statistics version 21.0. Cumulative incidences were estimated using EZR version 1.27 (Saitama Medical Center, Jichi Medical University, Omiya, Japan), a graphical user interface for R (version 3.1.1).
Results
A total of 105 atografted patients were analyzed. Patient’s characteristics are in Table 1. The median follow up since ASCT was 73 months (0 – 274 months). Thirty-one percent (n=33) of patients were conditioned with CFM-TBI. The overall 5-years survival (OS) was 68.3% (58-77% - CI 95%) and the 5-year disease free survival (DFS) was 52% (42 61% - CI 95%). There were no differences regarding OS and DFS between the two conditioning regimens. The 5-years cumulative incidence (CI) of relapse was 0.48 (0.37-0.57, CI 95%). We detected 10 secondary neoplasm (myelodysplasia n=1, skin carcinoma n=2, lung carcinoma n=3, oropharingeal carcinoma n= 1, intestinal adenocarcinoma n=1, renal neoplasia n=1, bladder neoplasia n=1). The median time for the neoplastic event was 10.5 years (0-18.5 years). The CI of secondary neoplasias (2nd neoplasia) at 10 years was 10% (1-20%, CI 95%) and at last point of follow up (18.5 years) was 40% (13%>63%, CI 95%). There were no differences in the CI of 2nd neoplasias between BEAM and CFM-TBI. Non-neoplastic complications were present in 10% of patients (n=11). Three cases were infections grade 3-4 related to ASCT. Six cases had cardiac complications (5 acute coronary syndrome, 1 myocardiopathy) and 2 had pulmonary toxicity. The CI of non-2nd neoplastic complications at 10 year was 10% (1 – 25%, CI 95%).No differences were detected between the two conditioning regimens regarding non-neosplastic complications.(see Figure 1).
Table. 1. Patient’s characteristics | Frequency (n) | Percentage |
Age (years) | 51 years old (18-70 years) | |
Gender | Male: 62 | 59% |
Histology | Diffuse Large Cell Lymphoma: 40 | 38% |
Follicular Lymphoma: 65 | 62% | |
Prognostic Index (IPI or FLIPI) (when available, n=103) | Low risk: 23; Intermediate risk: 67; High risk: 13 | 22%/65%/13% |
Response pre- ASCT | Complete Remission: 58 | 55% |
Partial Remission: 46 | 44% | |
Stable disease: 1 | 1% | |
Number of Lines pre-ASCT | 1 line: 11; 2 lines: 69; 3 lines: 18; 4 lines: 7 | 10%/66%/17%/7% |
Conditioning | CFM-TBI: 33 ; BEAM: 74 | 31% / 69% |
Conclusion
Autologous stem cell transplantation offers long disease free survival for half of the patients with a high risk non-Hodgkin lymphoma. In our series, patients conditioned with BEAM or CFM-TBI had a comparable incidence of neoplastic and non-neoplastic events
Session topic: 22. Stem cell transplantation - Clinical
Keyword(s): Late complications and outcome, Follicular lymphoma, Diffuse large B cell lymphoma, Autologous hematopoietic stem cell transplantation
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