Source:http://linkedlifedata.com/resource/pubmed/id/11707813
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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
1
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| pubmed:dateCreated |
2001-11-14
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| pubmed:abstractText |
The primary objective of this study was to evaluate the outcome of patients treated with high-dose chemo-/radiotherapy or high-dose chemotherapy and autologous stem-cell transplant (ASCT) for relapsed, refractory, or poor-risk intermediate-grade (IG) and high-grade (HG) non-Hodgkin's lymphoma (NHL). The secondary objectives were to determine prognostic factors for relapse and survival. Between February 1987 and August 1998, 264 patients, 169 (64%) IG and 95 (36%) HG, underwent high-dose therapy and ASCT at City of Hope National Medical Center (COHNMC). There were 157 (59%) males and 107 (41%) females with a median age of 44 years (range, 5-69 years). The median number of prior chemotherapy regimens was 2 (range, 1-4), and 71 (27%) had received prior radiation as part of induction or as salvage therapy. The median time from diagnosis to ASCT was 10.8 months (range, 3-158 months). Ninety-four patients (36%) underwent transplantation in first complete/partial remission (CR/PR), 40 (15%) in induction failure, and 130 (49%) in relapse or subsequent remission. Two preparative regimens were used: total body irradiation/high-dose etoposide/cyclophosphamide (TBI/VP/CY) in 208 patients (79%) and carmustine/etoposide/cyclophosphamide (BCNU/VP/CY) in 56 patients (21%). One hundred sixty-three patients (62%) received peripheral blood stem cells (PBSC) and 101 (38%) received bone marrow (BM) alone or BM plus PBSC. At a median follow-up of 4.43 years for surviving patients (range, 1-12.8 years), the 5-year Kaplan-Meier estimates of probability of overall survival (OS), progression-free survival (PFS), and relapse for all patients are 55% (95% confidence interval [CI]: 49%-61%), 47% (95% CI: 40%-53%), and 47% (95% CI: 40%-54%), respectively. There were 27 deaths (10%) from nonrelapse mortality, including seven (3%) patients who developed second malignancies (five with myelodysplasia/acute myelogenous leukemia and two with solid tumors). By stepwise Cox regression analysis, disease status at ASCT was the only prognostic factor that predicted for both relapse and survival. The 5-year probability of PFS for patients transplanted in first CR/PR was 73% (95% CI: 62%-81%) as compared to 30% (95% CI: 16%-45%) for induction failure and 34% (95% CI: 26%-42%) for relapsed patients. Our results further support the role of high-dose therapy and ASCT during first CR/PR for patients with poor-risk intermediate- and high-grade NHL. Early transplant is recommended for patients failing initial induction therapy or relapsing after chemotherapy-induced remission. Relapse continues to be the most common cause of treatment failure. An alternative approach to prevent relapse, the incorporation of radioimmunotherapy into the high-dose regimen, is being investigated. The development of a second malignancy is a serious complication of high-dose therapy, which requires close surveillance.
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| pubmed:grant | |
| pubmed:language |
eng
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| pubmed:journal | |
| pubmed:citationSubset |
IM
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| pubmed:status |
MEDLINE
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| pubmed:month |
Jun
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| pubmed:issn |
1526-9655
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| pubmed:author |
pubmed-author:BhatiaRR,
pubmed-author:ChowWW,
pubmed-author:DagisAA,
pubmed-author:FormanS JSJ,
pubmed-author:FungHH,
pubmed-author:KashyapAA,
pubmed-author:KrishnanAA,
pubmed-author:MargolisPP,
pubmed-author:MolinaAA,
pubmed-author:NademaneeAA,
pubmed-author:NilandJ CJC,
pubmed-author:O'DonnellM RMR,
pubmed-author:ParkerPP,
pubmed-author:PlanasII,
pubmed-author:SlovakMM,
pubmed-author:SmithEE,
pubmed-author:SniecinskiII,
pubmed-author:SnyderD SDS,
pubmed-author:SomloGG,
pubmed-author:SpielbergerRR,
pubmed-author:SteinAA,
pubmed-author:VoraNN,
pubmed-author:WongK KKK
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| pubmed:issnType |
Print
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| pubmed:volume |
1
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| pubmed:owner |
NLM
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| pubmed:authorsComplete |
Y
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| pubmed:pagination |
46-54
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| pubmed:dateRevised |
2009-11-3
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| pubmed:meshHeading |
pubmed-meshheading:11707813-Adolescent,
pubmed-meshheading:11707813-Adult,
pubmed-meshheading:11707813-Aged,
pubmed-meshheading:11707813-Antineoplastic Combined Chemotherapy Protocols,
pubmed-meshheading:11707813-Bone Marrow Transplantation,
pubmed-meshheading:11707813-Child,
pubmed-meshheading:11707813-Child, Preschool,
pubmed-meshheading:11707813-Combined Modality Therapy,
pubmed-meshheading:11707813-Disease-Free Survival,
pubmed-meshheading:11707813-Drug Resistance, Neoplasm,
pubmed-meshheading:11707813-Female,
pubmed-meshheading:11707813-Follow-Up Studies,
pubmed-meshheading:11707813-Hematopoietic Stem Cell Transplantation,
pubmed-meshheading:11707813-Humans,
pubmed-meshheading:11707813-Lymphoma, Non-Hodgkin,
pubmed-meshheading:11707813-Male,
pubmed-meshheading:11707813-Middle Aged,
pubmed-meshheading:11707813-Neoplasm Recurrence, Local,
pubmed-meshheading:11707813-Prognosis,
pubmed-meshheading:11707813-Risk Factors,
pubmed-meshheading:11707813-Survival Rate,
pubmed-meshheading:11707813-Transplantation, Autologous,
pubmed-meshheading:11707813-Whole-Body Irradiation
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| pubmed:year |
2000
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| pubmed:articleTitle |
Autologous stem-cell transplantation for poor-risk and relapsed intermediate- and high-grade non-Hodgkin's lymphoma.
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| pubmed:affiliation |
Division of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA. anademanee@coh.org
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| pubmed:publicationType |
Journal Article,
Research Support, U.S. Gov't, P.H.S.
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