Middle East Journal of Cancer

Outcomes of Autologous Stem Cell Transplantation for Non-Hodgkin Lymphoma Patients at a Tertiary Referral Centre

Document Type : Original Article(s)

Authors

Ajay Prakash 1
Hugh Goodman 2

1 Division of Oncology, Saskatchewan Cancer Agency, College of Medicine, University of Saskatchewan, Regina, Canada

2 Department of Hematology, Waikato Hospital, Hamilton, New Zealand

https://doi.org/10.30476/mejc.2022.93676.1703
Abstract
Background: Autologous stem cell transplant (ASCT) has been used as a consolidative treatment modality in non-Hodgkin’s lymphoma (NHL), but its role in NHL management is still evolving. The study aimed to evaluate the patient outcomes based on age, NHL subtypes, and conditioning regimen.
Method: We performed a retrospective analysis of NHL patients who received ASCT (n = 140) in our centre from 1992-2015. Data were gathered for this investigation using electronic records and case notes. Refractory illness, relapse, progressive disease, or death were all considered progression events. Time from ASCT to the last follow-up or progression event was used to define progression-free survival (PFS), and time from ASCT to death or the final follow-up was used to define overall survival (OS).
Results: Median age at ASCT was 55 years (16-68). Amongst patients ≤60 years (n = 109) and >60 years (n = 31), there was no significant difference in PFS (P = 0.756), OS (P = 0.711), neutrophil (12.5 vs. 11 days) and platelet (12 vs. 14 days) engraftment times. Amongst follicular lymphoma patients (n = 54) who received BEAM (carmustine, etoposide, cytarabine, melphalan) (n = 30) or Cy/TBI (cyclophosphamide/ total body irradiation) (n=24) conditioning, there was no significant difference between PFS (P = 0.111) and OS (P = 0.667). There was no significant difference (P = 0.46) in the incidence of second malignancies in the patient receiving BEAM or TBI-based conditioning.
Conclusion: ASCT can be safely performed for NHL in patients >60 years with outcomes similar to those ≤60 years. TBI based conditioning appear safe with similar outcomes to BEAM in follicular lymphoma patients. Prospective studies are needed to confirm these findings.

Keywords

Non-Hodgkin lymphoma
Stem cell transplant
Autologous
Total body irradiation
Transplantation conditioning

How to cite this article:

Prakash A, Goodman H. Outcomes of autologous stem cell transplantation for non- Hodgkin lymphoma patients at a tertiary referral centre. Middle East J Cancer. 2023;14(2):259- 69. doi: 10.30476/mejc.2022.93676.1703.

  1. Salles G, Seymour JF, Offner F, Lopez-Guillermo A, Belada D, Xerri L, et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet. 2011;377(9759):42-51. doi: 10.1016/S0140-6736(10)62175-7. Erratum in: Lancet. 2011;377(9772):1154.
  2. Hiddemann W, Kneba M, Dreyling M, Schmitz N, Lengfelder E, Schmits R, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood. 2005;106(12):3725-32. doi: 10.1182/blood-2005-01-0016.
  3. Morschhauser F, Radford J, Van Hoof A, Vitolo U, Soubeyran P, Tilly H, et al. Phase III trial of consolidation therapy with yttrium-90-ibritumomab tiuxetan compared with no additional therapy after first remission in advanced follicular lymphoma. J Clin Oncol. 2008;26(32):5156-64. doi:10.1200/JCO.2008.17.2015.
  4. Cote GM, Hochberg EP, Muzikansky A, Hochberg FH, Drappatz J, McAfee SL, et al. Autologous stem cell transplantation with thiotepa, busulfan, and cyclophosphamide (TBC) conditioning in patients with CNS involvement by non-Hodgkin lymphoma. Biol Blood Marrow Transplant. 2012;18(1):76-83. doi: 10.1016/j.bbmt.2011.07.006.
  5. Chen YB, Lane AA, Logan B, Zhu X, Akpek G, Aljurf M, et al. Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2015;21(6):1046-53. doi: 10.1016/j.bbmt.2015.02.005.
  6. Jantunen E, Itala M, Juvonen E, Leppa S, Keskinen L, Vasala K, et al. Autologous stem cell transplantation in elderly (>60 years) patients with non-Hodgkin's lymphoma: a nation-wide analysis. Bone Marrow Transplant. 2006;37(4):367-72. doi: 10.1038/sj.bmt.1705266.
  7. Brown JR, Yeckes H, Friedberg JW, Neuberg D, Kim H, Nadler LM, et al. Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin’s lymphoma. J Clin Oncol. 2005;23:2208-14. doi:10.1200/JCO.2005.05.158.
  8. Micallef IN, Lillington DM, Apostolidis J, Amess JA, Neat M, Matthews J, et al. Therapy-related myelodysplasia and secondary acute myelogenous leukemia after high-dose therapy with autologous hematopoietic progenitor-cell support for lymphoid malignancies. J Clin Oncol. 2000;18(5):947-55. doi:10.1200/JCO.2000.18.5.947.
  9. Vaxman I, Ram R, Gafter-Gvili A, Vidal L, Yeshurun M, Lahav M, et al. Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis. Bone Marrow Transplant. 2015;50(5):706-14. doi:10.1038/bmt.2014.325.
  10. Metayer C, Curtis RE, Vose J, Sobocinski KA, Horowitz MM, Bhatia S, et al. Myelodysplastic syndrome and acute myeloid leukemia after autotransplantation for lymphoma: a multicentre case-control study. Blood. 2003;101(5):2015-23. doi: 10.1182/blood-2002-04-1261.
  11. van Leeuwen FE. Risk of acute myelogenous leukaemia and myelodysplasia following cancer treatment. Baillieres Clin Haematol. 1996;9(1):57-85. doi: 10.1016/s0950-3536(96)80037-0.
  12. Rohatiner AZ, Nadler L, Davies AJ, Apostolidis J, Neuberg D, Matthews J, et al. Myeloablative therapy with autologous bone marrow transplantation for follicular lymphoma at the time of second or subsequent remission: long-term follow-up. J Clin Oncol. 2007;25(18):2554-9. doi: 10.1200/JCO.2006.09.8327.
  13. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999;17(4):1244. doi:10.1200/JCO.1999.17.4.1244. Erratum in: J Clin Oncol. 2000;18(11):2351.
  14. Sorror ML, Storer BE, Maloney DG, Sandmaier BM, Martin PJ, Storb R. Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood. 2008;111(1):446-52.doi: 10.1182/blood-2007-07-098483.
  15. Sorror ML, Storb RF, Sandmaier BM, Maziarz RT, Pulsipher MA, Maris MB, et al. Comorbidity-age index: a clinical measure of biological age prior to allogeneic hematopoietic cell transplantation. J Clin Oncol. 2014;32(29):3249-56. doi: 10.1200/JCO.2013.53.8157.
  16. Hermet E, Cabrespine A, Guieze R, Garnier A, Tempescul A, Lenain P, et al. Autologous hematopoietic stem cell transplantation in elderly patients (≥ 70 years) with non-Hodgkin's lymphoma: A French Society of Bone Marrow Transplantation and Cellular Therapy retrospective study. J Geriatr Oncol. 2015;6(5):346-52. doi: 10.1016/j.jgo.2015.04.005.
  17. Dahi PB, Tamari R, Devlin SM, Maloy M, Bhatt V, Scordo M, et al. Favourable outcomes in elderly patients undergoing high-dose therapy and autologous stem cell transplantation for non-Hodgkin lymphoma. Biol Blood Marrow Transplant. 2014;20(12):2004-9. doi: 10.1016/j.bbmt.2014.08.019.
  18. Montoto S, Canals C, Rohatiner AZ, Taghipour G, Sureda A, Schmitz N, et al. Long-term follow-up of high-dose treatment with autologous haematopoietic progenitor cell support in 693 patients with follicular lymphoma: an EBMT registry study. Leukemia. 2007;21(11):2324-31. doi: 10.1038/sj.leu.2404850.
  19. El-Najjar I, Boumendil A, Luan JJ, Bouabdallah R, Thomson K, Mohty M, et al. The impact of total body irradiation on the outcome of patients with follicular lymphoma treated with autologous stem-cell transplantation in the modern era: a retrospective study of the EBMT Lymphoma Working Party. Ann Oncol. 2014;25(11):2224-9. doi: 10.1093/annonc/mdu440.
  20. Caballero MD, Perez-Simon JA, Iriondo A, Lahuerta JJ, Sierra J, Marin J, et al. High-dose therapy in diffuse large cell lymphoma: results and prognostic factors in 452 patients from the GEL-TAMO Spanish Cooperative Group. Ann Oncol. 2003;14(1):140-51. doi: 10.1093/annonc/mdg008.
  21. Oliansky DM, Czuczman M, Fisher RI, Irwin FD, Lazarus HM, Omel J, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of diffuse large B cell lymphoma: update of the 2001 evidence-based review. Biol Blood Marrow Transplant. 2011;17(1):20-47. doi:10.1016/j.bbmt.2010.07.008.
  22. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med. 1995;333(23):1540-5. doi:10.1056/NEJM199512073332305.
  23. Kim YR, Kim SJ, Cheong JW, Yang DH, Lee H, Eom HS, et al. The different roles of molecular classification according to upfront autologous stem cell transplantation in advanced-stage diffuse large B cell lymphoma patients with elevated serum lactate dehydrogenase. Ann Hematol. 2016;95(9):1491-501. doi: 10.1007/s00277-016-2729-4.
  24. Milligan DW, Ruiz De Elvira MC, Kolb HJ, Goldstone AH, Meloni G, Rohatiner AZ, et al. Secondary leukaemia and myelodysplasia after autografting for lymphoma: results from the EBMT. EBMT Lymphoma and Late Effects Working Parties. European Group for Blood and Marrow Transplantation. Br J Haematol. 1999;106(4):1020-6. doi: 10.1046/j.1365-2141.1999.01627.x.
  25. Kalaycio M, Rybicki L, Pohlman B, Sobecks R, Andresen S, Kuczkowski E, et al. Risk factors before autologous stem-cell transplantation for lymphoma predict for secondary myelodysplasia and acute myelogenous leukemia. J Clin Oncol. 2006;24:3604-10. doi: 10.1200/JCO.2006.06.0673.
  26. Hake CR, Graubert TA, Fenske TS. Does autologous transplantation directly increase the risk of secondary leukemia in lymphoma patients? Bone Marrow Transplant. 2007;39(2):59-70. doi: 10.1038/sj.bmt.1705547.

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