A dose escalation study for salvage chemotherapy in patients with refractory lymphoma prior to high-dose myeloablative therapy with stem cell transplantation

C-K LEE; M DEMAGALHAES-SILVERMAN; M HAYASHI; A SCHLUETER; R. G STRAUSS; R. J HOHL; R. D GINGRICH

doi:10.1038/sj.bmt.1703533

$A dose escalation study for salvage chemotherapy in patients with refractory lymphoma prior to high-dose myeloablative therapy with stem cell transplantation$

Journal article

Peer reviewed

A dose escalation study for salvage chemotherapy in patients with refractory lymphoma prior to high-dose myeloablative therapy with stem cell transplantation

C-K LEE, M DEMAGALHAES-SILVERMAN, M HAYASHI, A SCHLUETER, R. G STRAUSS, R. J HOHL and R. D GINGRICH

Bone marrow transplantation (Basingstoke), Vol.29(8), pp.647-652

2002

DOI: 10.1038/sj.bmt.1703533

PMID: 12180108

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Abstract

Chemosensitive response prior to transplantation has been shown to be most significant for survival post transplant. To estimate toxicity of a dose-intensive regimen that was to improve chemosensitive response rate, 15 patients with primary refractory lymphoma were enrolled in dose escalation of pre-transplant salvage chemotherapy. The first cycle had a fixed dose of ifosfamide 6 g/m2 and mitoxantrone 12 mg/m2, with arabinosyl cytosine (Ara-C) 2 g/m2, and methylprednisolone 2.0 g. Each cycle of the second and third had cisplatin 90 mg/m2, Ara-C 6 g/m2, methylprednisolone 2.0 g, and escalated doses of ifosfamide from 7.5 g/m2 to 15 g/m2 and mitoxantrone from 16 to 28 mg/m2. Blood stem cells were collected before the second cycle and ⩾3 × 106 CD34 cells/kg were infused 2 days after the second and third cycles, respectively. The maximum tolerated doses of ifosfamide and mitoxantrone were 11.25 g/m2 and 16 mg/m2, respectively. Acute renal failure and bacterial infection occurred as non-hematologic dose limiting toxicities. Eleven patients completed therapy. Five patients achieved complete remission and five had partial remission. Nine patients received autologous and four received allogeneic transplants. Currently, six are alive without evidence of disease, with a 3-year survival of 40%. Although preliminary, the regimen suggests acceptable toxicity and significant activity that warrants further study.

Antineoplastic Agents

Chemotherapy

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Bone marrow, stem cells transplantation. Graft versus host reaction

Pharmacology. Drug treatments

Transfusions. Complications. Transfusion reactions. Cell and gene therapy

Biological and medical sciences

Medical sciences

Details

Title: Subtitle: A dose escalation study for salvage chemotherapy in patients with refractory lymphoma prior to high-dose myeloablative therapy with stem cell transplantation
Creators: C-K LEE - Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, The University of Iowa, College of Medicine, Iowa City, IA, United States
M DEMAGALHAES-SILVERMAN - Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, The University of Iowa, College of Medicine, Iowa City, IA, United States
M HAYASHI - Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, The University of Iowa, College of Medicine, Iowa City, IA, United States
A SCHLUETER - Department of Pathology, The University of Iowa, College of Medicine, Iowa City, IA, United States
R. G STRAUSS - Department of Pathology and Pediatrics, The University of Iowa, College of Medicine, Iowa City, IA, United States
R. J HOHL - Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, The University of Iowa, College of Medicine, Iowa City, IA, United States
R. D GINGRICH - Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, The University of Iowa, College of Medicine, Iowa City, IA, United States
Resource Type: Journal article
Publication Details: Bone marrow transplantation (Basingstoke), Vol.29(8), pp.647-652
DOI: 10.1038/sj.bmt.1703533
PMID: 12180108
NLM abbreviation: Bone Marrow Transplant
ISSN: 0268-3369
eISSN: 1476-5365
Publisher: Nature Publishing Group; Basingstoke
Language: English
Date published: 2002
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Stead Family Department of Pediatrics; Pathology; Internal Medicine
Record Identifier: 9984047762102771

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