Outcome and toxicity of salvage treatment on patients relapsing after autologous hematopoietic stem cell transplantation--experience from a single center.
Patients with hematological malignancies who relapse after autologous stem cell transplantation (auto-SCT) generally have poor prognosis. Salvage treatment is often associated with severe toxicities. The aim of our study was to evaluate retrospectively the toxicity and outcome of rescue therapy in patients with acute leukemias, non-Hodgkin's lymphoma (NHL), Hodgkin's disease (HD) and multiple myeloma (MM) relapsing after auto-SCT. Fifty-four of the 62 patients who relapsed received some form of salvage chemotherapy. Six (10%) patients were treated by second stem cell transplantation, which was allogeneic in 5 cases. Toxicity of the salvage therapy was significant. As a result of adverse effects, salvage therapy had to be discontinued or reduced in 14 patients (26%). The outcome of salvage was evaluated after 90 days. Of the treated patients, 14 (26%) entered into complete remission with another 5 (9%) reaching partial response. The disease was stabilized in 5 patients (9%) but 30 (56%) patients were in progression or dead. Overall survival of the patients was poor with the median survival of 8.7 months after relapse and the leading cause of death being progressive disease. In conclusion, the development of new, more efficient regimens is critical if disease-free survival is to be increased in patients who relapse after auto SCT.
Department of Clinical Hematology, "Institut Català d'Oncologia", Barcelona, Spain. tbuchler@fnbrno.cz
Tomas
T
Büchler
Mar
M
Hermosilla
Christelle
C
Ferra
Maite
M
Encuentra
David
D
Gallardo
Juan
J
Berlanga
Josep
J
Sarra
Albert
A
Grañena
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001549:Benzamides; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D007371:Interferon-gamma / Q000009:adverse effects / Q000627:therapeutic use; D007376:Interleukin-2 / Q000009:adverse effects / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy / Q000706:statistics & numerical data; D016019:Survival Analysis; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001549:Benzamides; D007155:Immunologic Factors; D007376:Interleukin-2; D010879:Piperazines; D011743:Pyrimidines; D000069283:Rituximab; D013792:Thalidomide; D007371:Interferon-gamma; D000068877:Imatinib Mesylate