title: Risk-adapted, treosulfan-based therapy with auto- and allo-SCT for relapsed/refractory aggressive NHL: a prospective phase-II trial.
abstract: Since the outcome of relapsed/refractory aggressive non-Hodgkin's lymphoma (NHL) is highly variable, a risk-adapted treatment approach was evaluated. After two cycles of DHAP, patients received high-dose treosulfan/etoposide/carboplatinum (TEC) and autologous stem cell rescue. After TEC, low-risk patients with late relapse (>1 year after first CR who achieved CR after DHAP received no further treatment. Patients with late relapse who achieved CR or PR only after TEC underwent a second cycle of TEC. High-risk patients with early relapse/refractory disease received treosulfan/fludarabine followed by allogeneic transplantation. Rituximab was added in patients with B-cell lymphoma (86%). At entry, 36% of all 57 patients had refractory disease, 32% early and 32% late relapse. During DHAP treatment, progression occurred in 32% of patients. Of 33 patients who received TEC, 5 received second TEC and 15 allogeneic transplantation. Main toxicity after TEC was oral mucositis (CTC grades 3 and 4 in 50% and 13%, respectively). In total, 42% patients achieved CR. Median OS was 21.4 months for all patients and 32.6 for those who underwent allogeneic transplantation. International prognostic index (IPI) at study entry was highly discriminative at predicting OS (P<0.0001). Risk-adapted, treosulfan-based therapy with auto- and allo-SCT is feasible. Long-term survival is possible with allogeneic transplantation.
authors.affiliation: Onkologisches Ambulanzzentrum, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Koenigsmann
authors.affiliation: Klinik für Onkologie und Hämatologie Klinikum, Oldenburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Casper
authors.affiliation: Klinik für Hämatologie und Internistische Onkologie Klinikum, Magdeburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kahl
authors.affiliation: Medizinische Klinik I, Malteserkrankenhaus St Franziskus Hospital, Flensburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Basara
authors.affiliation: Abteilung für Hämatologie und Onkologie, Klinik für Innere Medizin II, Universitätsklinik, Jena, Germany.
authors.forename: H G
authors.initials: HG
authors.lastname: Sayer
authors.affiliation: Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinik, Leipzig, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Behre
authors.affiliation: Klinik I für Innere Medizin, Universitätsklinik, Köln, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Theurich
authors.affiliation: Klinik und Poliklinik für Innere Medizin IV, Universitätsklinikum, Halle, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Christopeit
authors.affiliation: Klinik für Innere Medizin, Johanniter-Krankenhaus, Stendal, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mohren
authors.affiliation: Klinik für Hämatologie und Internistische Onkologie, Universitätsklinikum, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Reichle
authors.affiliation: Klinik für Onkologie und Hämatologie Klinikum, Oldenburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Metzner
authors.affiliation: Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ganser
authors.affiliation: Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stadler
authors.affiliation: Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Uharek
authors.affiliation: Evangelisches Krankenhaus, Hamm, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Balleisen
authors.affiliation: Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hinke
authors.affiliation: Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Hinke
authors.affiliation: Klinik I für Innere Medizin, Universitätsklinik, Köln, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage / Q000031:analogs & derivatives; D016190:Carboplatin / Q000008:administration & dosage; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D000069283:Rituximab; D033581:Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D005047:Etoposide; D016190:Carboplatin; C018404:treosulfan; D002066:Busulfan