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Conditioning Regimens

High-dose treosulfan in patients with relapsed or refractory high-grade lymphoma receiving tandem autologous blood stem cell transplantation

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This phase I/II study evaluated high-dose treosulfan in patients with high-grade lymphoma. In all, 21 patients (median age 51, 25–60 years) with primary refractory disease (n=3) or early (n=11) or late (n=7) relapse received DexaBEAM and one course etoposide for cytoreduction and PBPC mobilization. Subsequently, 16 patients received 30 g/m2 treosulfan and 140 mg/m2 melphalan, followed by autologous transplantation. Nine patients received a 2nd high-dose treatment (HDT) with 30 g/m2 treosulfan and 750 mg/m2 thiotepa. Recovery time to >1/nl leukocytes and >25/nl thrombocytes was 8.9 (range 8–11) and 11.9 (8–16) days after 1st and 9.6 (7–13) and 13 (9–19) days after 2nd HDT. Reversible grade 3 or 4 nonhematologic toxicities included mucositis (n=7), infection (n=7) and one episode of re-entry tachycardia. Two treatment-related deaths occurred after 2nd HDT. Since three dose-limiting toxicities occurred among nine patients receiving tandem HDT, 30 g/m2 of treosulfan was considered MTD in this setting. Patients with late compared to early relapse or refractory disease had a higher probability of CR (6/7 vs 3/14 patients, P=0.017) and overall survival (71 vs 21%, P<0.05, 24–49 months follow-up). In conclusion, high-dose treosulfan as major therapy component induces sustained complete remissions in relapsed high-grade lymphoma with acceptable toxicity.

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Authors and Affiliations

  1. Clinic of Hematology/Oncology, Germany

    M Koenigsmann, M Mohren, K Jentsch-Ullrich & A Franke

  2. Institute for Transfusion Medicine and Immunohematology, Germany

    E Becker & M Heim

  3. University Magdeburg and Clinic of Hematology/Oncology, University Rostock, Germany

    M Freund & J Casper

Authors
  1. M Koenigsmann
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  2. M Mohren
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  3. K Jentsch-Ullrich
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  4. A Franke
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  5. E Becker
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  6. M Heim
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  7. M Freund
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  8. J Casper
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Correspondence to M Koenigsmann.

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Koenigsmann, M., Mohren, M., Jentsch-Ullrich, K. et al. High-dose treosulfan in patients with relapsed or refractory high-grade lymphoma receiving tandem autologous blood stem cell transplantation. Bone Marrow Transplant 34, 477–483 (2004). https://doi.org/10.1038/sj.bmt.1704626

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  • DOI: https://doi.org/10.1038/sj.bmt.1704626

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