TY - JOUR
T1 - High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma
AU - Alkhaldi, Hanan
AU - Reinhardt, Alec
AU - Barnett, Melissa
AU - Kundu, Suprateek
AU - Hosing, Chitra
AU - Ramdial, Jeremy
AU - Saini, Neeraj
AU - Srour, Samer
AU - Alousi, Amin
AU - Kebriaei, Partow
AU - Popat, Uday
AU - Qazilbash, Muzaffar
AU - Champlin, Richard
AU - Shpall, Elizabeth J.
AU - Gulbis, Allison
AU - Shigle, Terri Lynn
AU - Dabaja, Bouthaina
AU - Pinnix, Chelsea
AU - Ahmed, Sairah
AU - Steiner, Raphael
AU - Andersson, Borje S.
AU - Nieto, Yago
N1 - Publisher Copyright:
© 2023 The American Society for Transplantation and Cellular Therapy
PY - 2023/11
Y1 - 2023/11
N2 - Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy with or without radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC), with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. The 60 study patients received either rituximab-BEAM (n = 37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) with or without vorinostat (n = 23), followed by ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range,.3 to 21 years), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group were 58% and 77%, respectively, for the entire cohort, 51% and 65% for the R-BEAM recipients, and 69% and 82% for R-vorinostat/GemBuMel recipients. Multivariable analyses showed that a negative positron emission tomography scan at ASCT (hazard ratio [HR],.28) and involvement of only 1 organ (HR,.33) were independently associated with improved PFS. In addition, receipt of R-vorinostat/GemBuMel (HR,.23) was an independent favorable predictor of OS. Our data indicate that HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.
AB - Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy with or without radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC), with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. The 60 study patients received either rituximab-BEAM (n = 37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) with or without vorinostat (n = 23), followed by ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range,.3 to 21 years), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group were 58% and 77%, respectively, for the entire cohort, 51% and 65% for the R-BEAM recipients, and 69% and 82% for R-vorinostat/GemBuMel recipients. Multivariable analyses showed that a negative positron emission tomography scan at ASCT (hazard ratio [HR],.28) and involvement of only 1 organ (HR,.33) were independently associated with improved PFS. In addition, receipt of R-vorinostat/GemBuMel (HR,.23) was an independent favorable predictor of OS. Our data indicate that HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.
KW - Autologous stem cell transplantation
KW - High-dose chemotherapy
KW - Primary mediastinal large B cell lymphoma
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U2 - 10.1016/j.jtct.2023.08.019
DO - 10.1016/j.jtct.2023.08.019
M3 - Article
C2 - 37607645
AN - SCOPUS:85171391154
SN - 2666-6367
VL - 29
SP - 690
EP - 694
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 11
ER -