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Post-Transplant Complications

Risk-adapted, treosulfan-based therapy with auto- and allo-SCT for relapsed/refractory aggressive NHL: a prospective phase-II trial

Bone Marrow Transplantation volume 49, pages 410–415 (2014)Cite this article

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Abstract

Since the outcome of relapsed/refractory aggressive non-Hodgkin’s lymphoma (NHL) is highly variable, a risk-adapted treatment approach was evaluated. After two cycles of DHAP, patients received high-dose treosulfan/etoposide/carboplatinum (TEC) and autologous stem cell rescue. After TEC, low-risk patients with late relapse (>1 year after first CR who achieved CR after DHAP received no further treatment. Patients with late relapse who achieved CR or PR only after TEC underwent a second cycle of TEC. High-risk patients with early relapse/refractory disease received treosulfan/fludarabine followed by allogeneic transplantation. Rituximab was added in patients with B-cell lymphoma (86%). At entry, 36% of all 57 patients had refractory disease, 32% early and 32% late relapse. During DHAP treatment, progression occurred in 32% of patients. Of 33 patients who received TEC, 5 received second TEC and 15 allogeneic transplantation. Main toxicity after TEC was oral mucositis (CTC grades 3 and 4 in 50% and 13%, respectively). In total, 42% patients achieved CR. Median OS was 21.4 months for all patients and 32.6 for those who underwent allogeneic transplantation. International prognostic index (IPI) at study entry was highly discriminative at predicting OS (P<0.0001). Risk-adapted, treosulfan-based therapy with auto- and allo-SCT is feasible. Long-term survival is possible with allogeneic transplantation.

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Acknowledgements

We thank Professor Dr Astrid Franke, former Director of the Department of Hematology and Oncology, University of Magdeburg, and Professor Dr Mathias Freund, former Director of the Department of Hematology and Oncology University of Rostock, Germany, for supporting this study. This work was supported (in part) by research funding by Medac, Gesellschaft für klinische Spezialpräparate mbH, Wedel, Germany; F. Hoffmann-La Roche AG, Grenzach, Germany; and Amgen GmbH, München, Germany (to MK). JC has received research funding and honoraria from Medac.

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Authors and Affiliations

  1. Onkologisches Ambulanzzentrum, Hannover, Germany

    M Koenigsmann

  2. Klinik für Onkologie und Hämatologie Klinikum, Oldenburg, Germany

    J Casper & B Metzner

  3. Klinik für Hämatologie und Internistische Onkologie Klinikum, Magdeburg, Germany

    C Kahl

  4. Medizinische Klinik I, Malteserkrankenhaus St Franziskus Hospital, Flensburg, Germany

    N Basara

  5. Abteilung für Hämatologie und Onkologie, Klinik für Innere Medizin II, Universitätsklinik, Jena, Germany

    H G Sayer

  6. Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinik, Leipzig, Germany

    G Behre

  7. Klinik I für Innere Medizin, Universitätsklinik, Köln, Germany

    S Theurich & D Niederwieser

  8. Klinik und Poliklinik für Innere Medizin IV, Universitätsklinikum, Halle, Germany

    M Christopeit

  9. Klinik für Innere Medizin, Johanniter-Krankenhaus, Stendal, Germany

    M Mohren

  10. Klinik für Hämatologie und Internistische Onkologie, Universitätsklinikum, Regensburg, Germany

    A Reichle

  11. Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule, Hannover, Germany

    A Ganser & M Stadler

  12. Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Berlin, Germany

    L Uharek

  13. Evangelisches Krankenhaus, Hamm, Germany

    L Balleisen

  14. Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany

    A Hinke & R Hinke

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  1. M Koenigsmann
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Correspondence to M Koenigsmann.

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Koenigsmann, M., Casper, J., Kahl, C. et al. Risk-adapted, treosulfan-based therapy with auto- and allo-SCT for relapsed/refractory aggressive NHL: a prospective phase-II trial. Bone Marrow Transplant 49, 410–415 (2014). https://doi.org/10.1038/bmt.2013.199

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  • DOI: https://doi.org/10.1038/bmt.2013.199

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