Trofosfamide as salvage therapy for anaplastic large cell lymphoma relapsing after high-dose chemotherapy.
Patients with relapsed aggressive lymphoma after high dose chemotherapy have a very poor prognosis and long-term survival is rare. Most patients are not eligible for allogeneic stem cell transplantation in this setting and treatment, therefore, becomes palliative. A few studies have shown that trofosfamide, an oral alkylating agent, may be effective as palliative treatment in non-Hodgkin's lymphoma. Trofosfamide therapy is considered rather non-toxic with an overall response rate from 50 to 80%. Most responses are, however, partial and their duration is short. We report a patient with a very aggressive ALK + anaplastic large cell lymphoma (ALCL), relapsing shortly after high dose chemotherapy. Unrelated allogeneic transplantation was hot possible. After several radio/chemotherapy regimens trofosfamide was started as palliative treatment. This therapy resulted in a complete remission, still ongoing, 27 months after termination of intravenous cytotoxic therapy and 16 months after withdrawal of trofosfamide. Thus, in this particular case, trofosfamide turned out to be an unexpectedly effective salvage therapy for an otherwise very aggressive relapsing ALCL.
Andersson
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PO
Haematology and Coagulation Section, Sahlgrenska University Hospital, S-413 45, Göteborg, Sweden. per-ola.andersson@medic.gu.se
Braide
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I
Nilsson-Ehle
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D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D010166:Palliative Care; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; C003726:trofosfamide