Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas

Revista Brasileira de Hematologia e Hemoterapia

Bruno Kosa Lino Duarte²  Eliana Cristina Martins Miranda¹  Marcio Nucci¹  Afonso Celso Vigorito²  Francisco José Penteado²  José Francisco Comenalli Marques Jr²  Gislaine Borba Oliveira-duarte²  Irene Gyongyver Heidemarie Lorand-metze²  Katia Borgia Pagnano²  Marcia Torresan Delamain²  Renata Baldissera¹  Isabella Salvetti Valente²  Carmino Antonio De Souza² 

[1] ,Universidade Estadual de Campinas Hematology and Hemotherapy Center Campinas SP ,Brazil

关键词: Transplantation;    autologous;    Hodgkin disease;    Lymphoma;    Lymphoma;    non-Hodgkin;    Antineoplastic Combined Chemotherapy Protocols;    Cyclophosphamide;    Hematopoietic stem cell transplantation;   

DOI  :  10.5581/1516-8484.20110118

来源: SciELO

【 摘 要 】

OBJECTIVE: To evaluate the use of high-dose sequential chemotherapy in a Brazilian population. METHODS: High-dose cyclophosphamide followed by autologous hematopoietic stem cell transplantation is an effective and feasible therapy for refractory/relapsed lymphomas; this regimen has never before been evaluated in a Brazilian population. All patients (106 with high-grade non-Hodgkin lymphoma and 77 with Hodgkin's lymphoma) submitted to this treatment between 1998 and 2006 were analyzed. Chemotherapy consisted of the sequential administration of high-dose cyclophosphamide (4 or 7 g/m²) and granulocyte-colony stimulating factor (300 µg/day), followed by peripheral blood progenitor cell harvesting, administration of etoposide (2g/m²) and methotrexate (8 g/m² only for Hodgkin's lymphoma) and autologous hematopoietic stem cell transplantation. RESULTS: At diagnosis, non-Hodgkin lymphoma patients had a median age of 45 (range: 8-65) years old, 78% had diffuse large B-cell lymphoma and 83% had stage III/IV disease. The Hodgkin's lymphoma patients had a median age of 23 (range: 7-68) years old, 64.9% had the nodular sclerosis subtype and 65% had stage III/IV disease. Nine Hodgkin's lymphoma patients (13%) and 10 (9%) non-Hodgkin lymphoma patients had some kind of cardiac toxicity. The overall survival, disease-free survival and progression-free survival in Hodgkin's lymphoma were 29%, 59% and 26%, respectively. In non-Hodgkin lymphoma, these values were 40%, 49% and 31%, respectively. High-dose cyclophosphamide-related mortality was 10% for Hodgkin's lymphoma and 5% for non-Hodgkin lymphoma patients. High-dose cyclophosphamide dosing had no impact on toxicity or survival for both groups. CONCLUSIONS: Despite a greater prevalence of poor prognostic factors, our results are comparable to the literature. The incidence of secondary neoplasias is noteworthy. Our study suggests that this approach is efficient and feasible, regardless of toxicity-related mortality.

【 授权许可】

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