Abstract
Purpose: High-dose chemotherapy with peripheral blood progenitor cell (PBPC) autograft is effective in high-risk lymphoma, particularly with the addition of rituximab; however, it is associated with risk of secondary malignancy. These issues have been addressed in a series of 1,347 patients with lymphoma treated with a high-dose sequential (HDS) program. Patients and Methods: A total of 1,024 patients with B-cell lymphoma, 234 patients with Hodgkin's lymphoma, and 89 patients with T-cell lymphoma were treated with HDS between 1985 and 2005 at 11 Gruppo Italiano Terapie Innovative Linfomi centers. HDS was given as salvage treatment to 707 patients (52%); 655 patients (49%) received a modified HDS, with high-dose cytarabine and two consecutive PBPC harvests. Rituximab-supplemented HDS was given to 523 patients (39%). Results: At a median follow-up of 7 years, the median overall survival (OS) was 16.2 years; in B-cell lymphoma the OS was significantly superior with rituximab HDS compared to HDS alone. The cumulative incidence at 5 and 10 years of secondary myelodysplasia/acute leukemia (sMDS/AL) were 3.09% and 4.52%, respectively, that of solid tumors were 2.54% and 6.79%, respectively. Factors associated with sMDS/AL were male sex and use of the second harvest PBPC for the graft; factors found to be associated with solid tumor were advanced age, post-HDS radiotherapy, and rituximab addition to HDS. Despite the increased risk of solid tumors, rituximab addition to HDS was still associated with survival advantages. Conclusion: This analysis has relevant implications for the design and use of intensive chemoimmunotherapy with autograft. In addition, it offers useful insights toward the understanding and prevention of tumor development.
| Original language | English |
|---|---|
| Pages (from-to) | 814-824 |
| Number of pages | 11 |
| Journal | Journal of Clinical Oncology |
| Volume | 29 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Mar 1 2011 |
Fingerprint
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
Risk factors for the development of secondary malignancy after high-dose chemotherapy and autograft, with or without rituximab : A 20-year retrospective follow-up study in patients with lymphoma. / Tarella, Corrado; Passera, Roberto; Magni, Michele; Benedetti, Fabio; Rossi, Andrea; Gueli, Angela; Patti, Caterina; Parvis, Guido; Ciceri, Fabio; Gallamini, Andrea; Cortelazzo, Sergio; Zoli, Valerio; Corradini, Paolo; Carobbio, Alessandra; Mulé, Antonino; Bosa, Marco; Barbui, Anna; Di Nicola, Massimo; Sorio, Marco; Caracciolo, Daniele; Gianni, Alessandro M.; Rambaldi, Alessandro.
In: Journal of Clinical Oncology, Vol. 29, No. 7, 01.03.2011, p. 814-824.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk factors for the development of secondary malignancy after high-dose chemotherapy and autograft, with or without rituximab
T2 - A 20-year retrospective follow-up study in patients with lymphoma
AU - Tarella, Corrado
AU - Passera, Roberto
AU - Magni, Michele
AU - Benedetti, Fabio
AU - Rossi, Andrea
AU - Gueli, Angela
AU - Patti, Caterina
AU - Parvis, Guido
AU - Ciceri, Fabio
AU - Gallamini, Andrea
AU - Cortelazzo, Sergio
AU - Zoli, Valerio
AU - Corradini, Paolo
AU - Carobbio, Alessandra
AU - Mulé, Antonino
AU - Bosa, Marco
AU - Barbui, Anna
AU - Di Nicola, Massimo
AU - Sorio, Marco
AU - Caracciolo, Daniele
AU - Gianni, Alessandro M.
AU - Rambaldi, Alessandro
PY - 2011/3/1
Y1 - 2011/3/1
N2 - Purpose: High-dose chemotherapy with peripheral blood progenitor cell (PBPC) autograft is effective in high-risk lymphoma, particularly with the addition of rituximab; however, it is associated with risk of secondary malignancy. These issues have been addressed in a series of 1,347 patients with lymphoma treated with a high-dose sequential (HDS) program. Patients and Methods: A total of 1,024 patients with B-cell lymphoma, 234 patients with Hodgkin's lymphoma, and 89 patients with T-cell lymphoma were treated with HDS between 1985 and 2005 at 11 Gruppo Italiano Terapie Innovative Linfomi centers. HDS was given as salvage treatment to 707 patients (52%); 655 patients (49%) received a modified HDS, with high-dose cytarabine and two consecutive PBPC harvests. Rituximab-supplemented HDS was given to 523 patients (39%). Results: At a median follow-up of 7 years, the median overall survival (OS) was 16.2 years; in B-cell lymphoma the OS was significantly superior with rituximab HDS compared to HDS alone. The cumulative incidence at 5 and 10 years of secondary myelodysplasia/acute leukemia (sMDS/AL) were 3.09% and 4.52%, respectively, that of solid tumors were 2.54% and 6.79%, respectively. Factors associated with sMDS/AL were male sex and use of the second harvest PBPC for the graft; factors found to be associated with solid tumor were advanced age, post-HDS radiotherapy, and rituximab addition to HDS. Despite the increased risk of solid tumors, rituximab addition to HDS was still associated with survival advantages. Conclusion: This analysis has relevant implications for the design and use of intensive chemoimmunotherapy with autograft. In addition, it offers useful insights toward the understanding and prevention of tumor development.
AB - Purpose: High-dose chemotherapy with peripheral blood progenitor cell (PBPC) autograft is effective in high-risk lymphoma, particularly with the addition of rituximab; however, it is associated with risk of secondary malignancy. These issues have been addressed in a series of 1,347 patients with lymphoma treated with a high-dose sequential (HDS) program. Patients and Methods: A total of 1,024 patients with B-cell lymphoma, 234 patients with Hodgkin's lymphoma, and 89 patients with T-cell lymphoma were treated with HDS between 1985 and 2005 at 11 Gruppo Italiano Terapie Innovative Linfomi centers. HDS was given as salvage treatment to 707 patients (52%); 655 patients (49%) received a modified HDS, with high-dose cytarabine and two consecutive PBPC harvests. Rituximab-supplemented HDS was given to 523 patients (39%). Results: At a median follow-up of 7 years, the median overall survival (OS) was 16.2 years; in B-cell lymphoma the OS was significantly superior with rituximab HDS compared to HDS alone. The cumulative incidence at 5 and 10 years of secondary myelodysplasia/acute leukemia (sMDS/AL) were 3.09% and 4.52%, respectively, that of solid tumors were 2.54% and 6.79%, respectively. Factors associated with sMDS/AL were male sex and use of the second harvest PBPC for the graft; factors found to be associated with solid tumor were advanced age, post-HDS radiotherapy, and rituximab addition to HDS. Despite the increased risk of solid tumors, rituximab addition to HDS was still associated with survival advantages. Conclusion: This analysis has relevant implications for the design and use of intensive chemoimmunotherapy with autograft. In addition, it offers useful insights toward the understanding and prevention of tumor development.
UR - http://www.scopus.com/inward/record.url?scp=79952330285&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952330285&partnerID=8YFLogxK
U2 - 10.1200/JCO.2010.28.9777
DO - 10.1200/JCO.2010.28.9777
M3 - Article
VL - 29
SP - 814
EP - 824
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 7
ER -