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Safety and efficacy of high-dose ranimustine (MCNU) containing regimen followed by autologous stem cell transplantation for diffuse large B-cell lymphoma

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Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is widely used as a salvage therapy for relapsed or high-risk diffuse large B-cell lymphoma (DLBCL). To investigate the safety and efficacy of regimens including high-dose MCNU followed by ASCT for DLBCL, we analyzed the data from prospective multicenter trials. Twenty-nine patients were analyzed, and the median follow-up time for survival patients was 70 months. Fifteen patients received MCVC conditioning regimen, and fourteen patients received MEAM regimen. Major toxicities associated with these conditioning regimens included nausea (69%), anorexia (66%), febrile neutropenia (62%), diarrhea (59%), and mucositis (34%). One patient who developed severe sinusoidal obstructive syndrome and acute lung injury died without disease progression, and overall therapy-related mortality at 5 years was 3%. No patient developed therapy-related hematological malignancy. At 5 years, overall survival and progression-free survival in all patients were 82.8 and 58.2%, respectively. The 5-year OS in patients treated by the MCVC and MEAM regimens were 73.3 and 92.9%, respectively. These results suggest that regimens including high-dose MCNU followed by ASCT are feasible and effective for the treatment of relapsed or high-risk DLBCL. Further investigation is needed to evaluate of these regimens.

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References

  1. Epperla N, Hamadani M. Hematopoietic cell transplantation for diffuse large B-cell and follicular lymphoma: current controversies and advances. Hematol Oncol Stem Cell Ther. 2017;10:277–84.

    Article  PubMed  Google Scholar 

  2. Kirschey S, Flohr T, Wolf HH, Frickhofen N, Gramatzki M, Link H, et al. Rituximab combined with DexaBEAM followed by high dose therapy as salvage therapy in patients with relapsed or refractory B-cell lymphoma: mature results of a phase II multicentre study. Br J Haematol. 2015;168:824–34.

    Article  CAS  PubMed  Google Scholar 

  3. Krishnan AY, Palmer J, Nademanee AP, Chen R, Popplewell LL, Tsai NC, et al. Phase II study of yttrium-90 ibritumomab tiuxetan plus high-dose BCNU, etoposide, cytarabine, and melphalan for non-hodgkin lymphoma: the role of histology. Biol Blood Marrow Transpl. 2017;23:922–9.

    Article  CAS  Google Scholar 

  4. Hiraoka A, Masaoka T, Shibata H, Miyazaki T, Nakamura T, Yasunaga K, et al. A new nitrosourea derivative for the treatment of chronic myelogenous leukemia. Leuk Res. 1988;12:487–90.

    Article  CAS  PubMed  Google Scholar 

  5. Sugimoto M, Ito S, Mashima K, Umino K, Minakata D, Nakano H, et al. Retrospective evaluation of the MEAM regimen as a conditioning regimen before autologous peripheral blood stem cell transplantation for lymphoma in two centers with different dosing schedules of melphalan. Ann Hematol. 2016;95:1513–9.

    Article  CAS  PubMed  Google Scholar 

  6. Kameoka Y, Takahashi N, Ishizawa K, Kato Y, Ito J, Sasaki O, et al. Safety and feasibility of high-dose ranimustine (MCNU), carboplatin, etoposide, and cyclophosphamide (MCVC) therapy followed by autologous stem cell transplantation for malignant lymphoma. Int J Hematol. 2012;96:624–30.

    Article  CAS  PubMed  Google Scholar 

  7. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. International harmonization project on lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25:579–86.

    Article  PubMed  Google Scholar 

  8. Rozman C, Carreras E, Qian C, Gale RP, Bortin MM, Rowlings PA, et al. Risk factors for hepatic veno-occlusive disease following HLA-identical sibling bone marrow transplants for leukemia. Bone Marrow Transpl. 1996;17:75–80.

    CAS  Google Scholar 

  9. Todd NW, Peters WP, Ost AH, Roggli VL, Piantadosi CA. Pulmonary drug toxicity in patients with primary breast cancer treated with high-dose combination chemotherapy and autologous bone marrow transplantation. Am Rev Respir Dis. 1993;147:1264–70.

    Article  CAS  PubMed  Google Scholar 

  10. Stiff PJ, Dahlberg S, Forman SJ, McCall AR, Horning SJ, Nademanee AP, et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin’s lymphoma: value of augmented preparative regimens–a Southwest Oncology Group trial. J Clin Oncol. 1998;16:48–55.

    Article  CAS  PubMed  Google Scholar 

  11. Takaue Y, Watanabe T, Hoshi Y, Abe T, Matsunaga K, Saito S, et al. Effectiveness of high-dose MCNU therapy and hematopoietic stem cell autografts treatment of childhood acute leukemia/lymphoma with high-risk features. Cancer. 1991;67:1830–7.

    Article  CAS  PubMed  Google Scholar 

  12. Kato J, Mori T, Yokoyama K, Tsukada Y, Ueda T, Shimizu T, et al. Safety and efficacy of high-dose ranimustine, cytarabine, etoposide and CY (MCVAC) regimen followed by autologous peripheral blood stem cell transplantation for high-risk diffuse large B-cell lymphoma. Bone Marrow Transpl. 2011;46:923–8.

    Article  CAS  Google Scholar 

  13. Kobayashi Y, Hatta Y, Sugitani M, Hojo A, Nakagawa M, Kusuda M, et al. Safety and efficacy of high-dose cyclophosphamide, etoposide and ranimustine regimen followed by autologous peripheral blood stem cell transplant for patients with diffuse large B-cell lymphoma. Leuk Lymphoma. 2014;55:2514–9.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yoshihiro Kameoka.

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Kameoka, Y., Akagi, T., Murai, K. et al. Safety and efficacy of high-dose ranimustine (MCNU) containing regimen followed by autologous stem cell transplantation for diffuse large B-cell lymphoma. Int J Hematol 108, 510–515 (2018). https://doi.org/10.1007/s12185-018-2508-1

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  • DOI: https://doi.org/10.1007/s12185-018-2508-1

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