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Lymphoma and Plasma Cell Disorders
June 20, 2007

Impact of intensive stem cell mobilization therapy on outcomes following autologous stem cell transplantation (ASCT) for non- Hodgkin lymphoma (NHL)

Abstract

8119
Background: We retrospectively evaluated the impact of intense [I] stem cell mobilization therapy on event-free survival [EFS] and overall survival [OS] following ASCT for NHL. Methods: 80 patients (pt) were studied (2 Burkitt, 3 primary CNS, 3 follicular, 2 intravascular, 43 large cell, 12 mantle cell, 9 transformed, and 6 peripheral T-cell). Patients with very-high risk features (LDH > 500 IU/L, first remissions < 1 year, 2 or more extra-nodal sites, and/or primary CNS/intravascular/mantle cell/peripheral T-cell histology) were prospectively allocated to I stem cell mobilization (requiring hospitalization) with either cyclophosphamide [C] (6 g/m2) + etoposide [E] (2g/m2) + filgrastim [G-CSF] (±rituximab [R]) (n=5) or with cytarabine [A] (2 g/m2 bid for 8 doses) + E (40 mg/kg) + G- CSF (±R) (n=45). 30 pt were mobilized (outpatient) with C 4g/m2 + G-CSF ±R (non-intense [NI] mobilization). 76 pt received ASCT conditioning with carmustine [B] + E and C (CBV) and 2 with B + E + A and melphalan (BEAM); 2 pt did not undergo ASCT. Results: The median age was 54 (21–69 years [yr]) and 57% had an elevated LDH at presentation. 39 pt (49%) were primary induction failures (PIF). At NHL presentation, 38% were IPI high-intermediate or high risk. There were 3 non-relapse mortalities (4%): (2) B pneumonitis and (1) multi-organ failure (all following ASCT). With a median follow-up of 1.8 yr (0.1–6.4), the overall median EFS is 3 yr (48% [34–62] at 4 yr) and the median OS is 4.7 yr (59% [43–72] at 4 yr). Patients receiving I mobilization were similar to those receiving NI mobilization in terms of the # of prior therapies (median 2, each), the presenting IPI risk score, and the percent PIF (57% vs 41%; p=0.17). There were trends favoring I mobilization for both 4 yr EFS (58% [41–75] vs 35% [13–57]) and OS (66% [48–84] vs 52% [32–72]), neither statistically significant. In the sub-group of large B-cell NHL, 4 yr EFS was the same in pt receiving I mobilization (81% [63–98] vs 73% [50–96]; p=0.33) but OS was better (91% [79–100] vs 58% [35–82]; p=0.02). Conclusions: I stem cell mobilization therapy, compared to NI mobilization therapy, may improve outcomes for NHL pt with very-high risk features and may overcome the anticipated poor prognosis of these pt.
No significant financial relationships to disclose.

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Journal of Clinical Oncology
Pages: 8119

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Published online: June 20, 2007
Published in print: June 20, 2007

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L. E. Damon
Univ of California San Francisco, San Francisco, CA
L. Damon
Univ of California San Francisco, San Francisco, CA
L. Kaplan
Univ of California San Francisco, San Francisco, CA
T. Martin III
Univ of California San Francisco, San Francisco, CA
C. A. Linker
Univ of California San Francisco, San Francisco, CA

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L. E. Damon, L. Damon, L. Kaplan, T. Martin, C. A. Linker
Journal of Clinical Oncology 2007 25:18_suppl, 8119-8119

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