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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 131I-anti-CD20 antibody and stem cell rescue

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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 131I-anti-CD20 antibody (131I-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 131I-coupled anti-CD20 are manageable and effective but toxic treatment modalities for relapsed poor prognosis CD20+ B-NHL.

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Authors and Affiliations

  1. Department of Hematology and Oncology, University Medicine, Georg-August-University, Robert Koch Str. 40, 37075, Göttingen, Germany

    Karin Hohloch, Vijai J. Lakhani, Gerald Wulf, Justin Hasenkamp & Lorenz Trümper

  2. Department of Transfusion Medicine, University Medicine, Georg-August-University, Göttingen, Germany

    Joachim Riggert

  3. Department of Nuclear Medicine, University Medicine, Georg-August-University, Göttingen, Germany

    Carsten Oliver Sahlmann & Johannes Meller

  4. Section for Stem Cell Transplantation, Department of Hematology, Asklepios Hospital, Hamburg, Germany

    Bertram Glaß

  5. Department of Medical Oncology, Pius Hospital, Oldenburg, Germany

    Frank Griesinger

Authors
  1. Karin Hohloch
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  2. Carsten Oliver Sahlmann
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  3. Vijai J. Lakhani
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  4. Gerald Wulf
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  5. Bertram Glaß
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  6. Justin Hasenkamp
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  7. Johannes Meller
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  8. Joachim Riggert
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  9. Lorenz Trümper
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  10. Frank Griesinger
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Corresponding author

Correspondence to Karin Hohloch.

Additional information

Karin Hohloch and Carsten O. Sahlmann contributed equally to this manuscript.

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Hohloch, K., Sahlmann, C.O., Lakhani, V.J. et al. 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 131I-anti-CD20 antibody and stem cell rescue. Ann Hematol 90, 1307–1315 (2011). https://doi.org/10.1007/s00277-011-1199-y

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