title: Autologous transplantation for transformed non-Hodgkin lymphoma using an yttrium-90 ibritumomab tiuxetan conditioning regimen.
abstract: Transformation from indolent non-Hodgkin lymphoma (NHL) to diffuse large B cell lymphoma (DLBCL) has historically been associated with a poor prognosis. A small series of autologous stem cell transplantation (ASCT) studies using conventional conditioning regimens has demonstrated durable progression-free survival (PFS) rates ranging from 25% to 47%, but data in the rituximab era are lacking. Here we report the results of a multicenter retrospective trial evaluating ASCT in patients with transformed lymphoma using the Z-BEAM conditioning regimen, which combines yttrium-90-labeled ibritumomab tiuxetan (Zevalin) with high-dose BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy. Sixty-three patients from 4 institutions were treated between 2003 and 2011. Histological confirmation of transformation was required and defined as a diagnosis of DLBCL in patients with either a prior history or concomitant diagnosis of low-grade B cell NHL. Median patient age at ASCT was 59.5 years, median number of prior regimens was 2, and all patients were exposed to rituximab. Disease status at ASCT was as follows: first complete remission (CR) (n = 30), first partial remission (n = 11), first relapse (n = 14), and at least second CR (n = 8). The median time from diagnosis of histological transformation to ASCT was 7.5 months (range, 2.8 to 116). Two-year nonrelapse mortality was 0%. Median follow-up for living patients was 28 months (range, 5 to 103). Two-year PFS was 68% (95% confidence interval, 58% to 75%), and overall survival was 90% (95% confidence interval, 80% to 95%). In conclusion, the Z-BEAM conditioning regimen for ASCT is well tolerated by patients with transformed lymphoma and demonstrates encouraging clinical outcomes.
authors: Department of Hematology/HCT, City of Hope, Duarte, California.
authors: Matthew
authors: M
authors: Mei
authors: Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Marielle J
authors: MJ
authors: Wondergem
authors: Department of Biostatistics, City of Hope, Duarte, California.
authors: Joycelynne M
authors: JM
authors: Palmer
authors: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Aviv, Israel.
authors: Avichai
authors: A
authors: Shimoni
authors: Department of Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany.
authors: Justin
authors: J
authors: Hasenkamp
authors: Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Ni-Chun
authors: NC
authors: Tsai
authors: Department of Radiation Oncology, City of Hope, Duarte, California.
authors: Jennifer
authors: J
authors: Simpson
authors: Department of Hematology/HCT, City of Hope, Duarte, California.
authors: Auayporn
authors: A
authors: Nademanee
authors: Department of Radiation Oncology, City of Hope, Duarte, California.
authors: Andrew
authors: A
authors: Raubitschek
authors: Department of Hematology/HCT, City of Hope, Duarte, California.
authors: Stephen J
authors: SJ
authors: Forman
authors: Department of Hematology/HCT, City of Hope, Duarte, California. Electronic address: akrishnan@coh.org.
authors: Amrita Y
authors: AY
authors: Krishnan
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D064592:Autografts; D002330:Carmustine / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011034:Podophyllotoxin / Q000008:administration & dosage; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning
chemical_list: D000911:Antibodies, Monoclonal; D003561:Cytarabine; C422802:ibritumomab tiuxetan; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine
keywords: Radioimmunotherapy; Z-BEAM; Zevalin