title: Tandem high-dose therapy in relapsed and refractory B-cell lymphoma: results of a prospective phase II trial of myeloablative chemotherapy, followed by escalated radioimmunotherapy with (131)I-anti-CD20 antibody and stem cell rescue.
abstract: A phase II trial evaluated safety, feasibility and efficacy of a sequential tandem approach combining myeloablative BEAM chemotherapy and autologous stem cell transplantation (ASCT) with myeloablative radioimmunotherapy (HD-RIT), with (131)I-anti-CD20 antibody ((131)I-rituximab), followed by a second ASCT in patients with relapsed or refractory CD20+ B-cell lymphoma. According to protocol, 16 patients with relapsed (n = 14) and refractory (n = 2) CD20+ B-cell lymphoma received salvage therapy with rituximab and Dexa-BEAM, followed by BEAM (HD chemotherapy) and high-dose myeloablative radioimmunotherapy 2-6 months after BEAM. Nine of 16 patients received HD-RIT; seven patients were excluded before HD-RIT because of toxicity or progressive disease. Disease histologies were follicular lymphoma (FL) grades 1 and 2 (n = 4), transformed follicular (FL 3b; n = 6), diffuse large B-cell (DLBCL; n = 4), mantle cell (n = 1) and marginal zone lymphoma (n = 1). After a median follow-up of 50.4 months for OS and 39.7 months for progression-free survival (PFS), estimated 4-year OS and PFS were 67% and 64%, respectively. The estimated 4-year OS and PFS for patients with FL were 80% and 78%, respectively. Toxicity was significant, including one fatal outcome due to pneumonitis. Tandem transplants consisting of HD chemotherapy followed by HD-RIT with (131)I-coupled anti-CD20 are manageable and effective but toxic treatment modalities for relapsed poor prognosis CD20+ B-NHL.
authors.affiliation: Department of Hematology and Oncology, University Medicine, Georg-August-University, Robert Koch Str. 40, 37075 Göttingen, Germany. karo.hohloch@med.uni-goettingen.de
authors.forename: Karin
authors.initials: K
authors.lastname: Hohloch
authors.forename: Carsten Oliver
authors.initials: CO
authors.lastname: Sahlmann
authors.forename: Vijai J
authors.initials: VJ
authors.lastname: Lakhani
authors.forename: Gerald
authors.initials: G
authors.lastname: Wulf
authors.forename: Bertram
authors.initials: B
authors.lastname: Glass
authors.forename: Justin
authors.initials: J
authors.lastname: Hasenkamp
authors.forename: Johannes
authors.initials: J
authors.lastname: Meller
authors.forename: Joachim
authors.initials: J
authors.lastname: Riggert
authors.forename: Lorenz
authors.initials: L
authors.lastname: Trümper
authors.forename: Frank
authors.initials: F
authors.lastname: Griesinger
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000276:immunology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002330:Carmustine; D003131:Combined Modality Therapy; D003561:Cytarabine; D003907:Dexamethasone; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005047:Etoposide; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016393:Lymphoma, B-Cell / Q000517:prevention & control* / Q000628:therapy*; D008297:Male; D008558:Melphalan; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011446:Prospective Studies; D016499:Radioimmunotherapy / Q000379:methods*; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy; D033581:Stem Cell Transplantation
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D019653:Myeloablative Agonists; D003561:Cytarabine; D000069283:Rituximab; D005047:Etoposide; D003907:Dexamethasone; D008558:Melphalan; D002330:Carmustine