Highdose Chemotherapystem Cell Transplant

Chemo Secrets From a Breast Cancer Survivor

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Several groups have examined the impact of high-dose chemotherapy on T-cell lymphomas. Investigators at

MD Anderson Cancer Center performed a retrospective analysis of 36 patients with relapsed or refractory PTCL who received high-dose chemotherapy and autologous (29 patients) or allogeneic (7 patients) hematopoietic transplantation.88 The 3-year overall survival rate was 36%, and progression-free survival (PFS) rate was 28%. The 3-year probabilities of survival for the autologous and allogeneic groups were 39 and 29%, respectively, while the PFS rates at 3 years were 32 and 14%, respectively. The pretransplant serum LDH level was the most important prognostic factor for both overall survival and PFS results. Furthermore, patients with an IPI score of <1 had better overall survival, but not PFS rates, than those with greater IPI scores. At a median follow-up of 43 months, 13 patients (36%) were still alive with no evidence of disease. These data were comparable to published studies of high-dose chemotherapy for relapsed or refractory B-cell lymphomas, and suggested that stem cell transplant should be considered for selected patients with T-cell lymphomas. In a study reported by Vose et al., 41 patients with relapsed intermediate- or high-grade lymphomas (17 cases of T-cell and 24 cases of B-cell lymphomas) underwent high-dose therapy and autol-ogous transplantation for salvage therapy. Comparable results were obtained for B- and T-cell lymphomas.89 The T-cell patients had a slightly higher CR rate that was not statistically significant (59% compared to 42%), with the durations of response being similar (50% at 30 months, with no late relapses). The 2-year overall survival rates for both groups were also similar, being 35% for T-cell lymphomas and 30% for B-cell lymphomas, as were the 2-year disease-free survival rates (28% for the T-cell group and 17% for the B-cell patients). Predictors of poor outcome for both groups of patients were poor performance status, bulky tumor, and high LDH levels. A study involving 40 patients with relapsed T-cell lymphomas from Norway and Sweden also examined the role of high-dose therapy with autologous stem cell transplantation.90 All patients had chemosensitive disease and had received anthracy-cline-containing regimens, mainly CHOP, VACOP-B (etoposide, doxorubicin, cyclosphophamide, vincristine, prednisone, and bleomycin), or MACOP-B (methotrex-ate, doxorubicin, cyclophosphamide, vincristine, pred-nisone, and bleomycin), prior to transplantation. At the time of stem cell transplant, 17 patients were in first PR or CR, and 23 were in second or third PR or CR. Conditioning regimens included BEAM (carmustine, etoposide, cytarabine, and melphalan) in 15 patients, BEAC (carmustine, etoposide, cytarabine, and cyclophos-phamide) in 14, BEAC without etoposide and total body irradiation (TBI) in 1, cyclophosphamide and TBI in 8, and melphalan and mitoxantrone in 2. There were three (7.5%) treatment-related deaths; however, 32 patients (80%) achieved or maintained a CR after stem cell transplant, with relapses occurring in 16 patients, all within 2 years following transplantation.

Table 60.3 Results of phase II trials with pentostatin in T-cell lymphoma

Number Partial Study Lymphoma type of patients remissions

Complete remissions

Overall response rate (%)

Smyth et al.93

Lymphoblastic lymphoma

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