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Modified BEAM with triple autologous stem cell transplantation for patients with relapsed aggressive non-Hodgkin lymphoma

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Abstract

Treatment of relapse and primary progression in aggressive lymphoma remains unsatisfactory; outcome is still poor. Better treatment strategies are much needed for this patient population. The R1 study is a prospective multi-center phase I/II study evaluating a dose finding approach with a triple transplant regimen in four BEAM dose levels in patients with relapsed aggressive non-Hodgkin lymphoma. The aim of the study was to determine feasibility, toxicity, and remission rate. In a total of 39 patients (pts.) enrolled in the study, 24 pts. were evaluated in the following analysis. Twenty pts. had aggressive B cell lymphoma, and two pts. had T cell lymphoma. All evaluated patients responded to DexaBEAM with a sufficient stem cell harvest. The phase I/II study was started with BEAM dose level II. Four patients were treated at dose level II, and 20 pts. were treated at dose level III. Due to the early termination of the study, dose levels I and IV were never administered. Sixteen pts. completed therapy according to protocol, and eight pts. (33.3 %) stopped treatment early. Infections (27 %) and stomatitis (13 %) were the most frequent grade III/IV non-hematologic toxicities. Thirteen percent of patients presented with severe grade III/IV lung toxicity during modified BEAM (m-BEAM). Fourteen pts. achieved a complete response (CR), one pt. achieved no change (NC), six pts. had progressive disease (PD), and two pts. died; for one pt., outcome is not known. One-year and 3-year event-free survival (EFS) was 38 and 33 %, respectively. Overall survival (OS) after 1 and 3 years was 50 and 38 %. In conclusion, dose escalation of standard BEAM is not feasible due to toxicity.

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Author notes

  1. Björn Chapuy

    Present address: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

Authors and Affiliations

  1. Kantonsspital Graubünden, Hematology and Oncology, Chur, Switzerland

    Karin Hohloch

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

    Karin Hohloch, Björn Chapuy, Lorenz Trümper & Gerald Wulf

  3. Institute for Medical Informatics, Statistics, and Epidemiology, Universität Leipzig, Leipzig, Germany

    Samira Zeynalova, Markus Loeffler, Marita Ziepert & Dirk Hasenclever

  4. Department of Internal Medicine I, University Clinic of Saarland, Homburg, Germany

    Michael Pfreundschuh

  5. Department of Pathology, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Alfred C. Feller

  6. Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany

    Norbert Schmitz

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  1. Karin Hohloch
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Correspondence to Karin Hohloch.

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Karin Hohloch and Samira Zeynalova contributed equally to this work.

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Hohloch, K., Zeynalova, S., Chapuy, B. et al. Modified BEAM with triple autologous stem cell transplantation for patients with relapsed aggressive non-Hodgkin lymphoma. Ann Hematol 95, 1121–1128 (2016). https://doi.org/10.1007/s00277-016-2671-5

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