Rituximab: Enhancing stem cell transplantation in mantle cell lymphoma

A. M. Gianni, S. Cortelazzo, M. Magni, M. Martelli, C. Tarella, K. Patti, E. Pogliani, P. Corradini, G. Saglio, F. Benedetti

Research output: Contribution to journalArticle

Abstract

Mantle cell lymphoma (MCL) responds poorly to standard chemotherapy regimens used in non-Hodgkin's lymphoma. As a result, a combination of high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) is being investigated in patients with MCL. So far, however, there is no evidence for longterm remission - believed, in part, to be due to contamination of the transfusion product with residual cancer cells. Many ex-vivo purging methods have been developed to remove tumour cells, but these are complicated, time-consuming and expensive. This study describes an in vivo purging method using rituximab to produce a tumour-free stem cell product for re-infusion following HDT. The regimen is split into a purging phase and a myeloablative phase, which together consist of four-step high-dose sequential chemotherapy (sHDT) and six infusions of rituximab immunotherapy. The sHDT comprises cyclophosphamide, cytosine arabinoside, melphalan and mitoxantrone plus melphalan. There are two separate stem cell harvests and three reinfusions. In a pilot study 28 patients with untreated MCL received standard chemotherapy followed by sHDT with rituximab in vivo purging. Preliminary results indicate that in PCR analyses of leukaphereses from 20 assessable patients, 100% lymphoma-negative harvests were achieved following in vivo purging. PCR analyses of the bone marrow following the four-step high-dose regimen with purging and transplantation showed that all patients achieved molecular remission. After a median follow-up of 22 months (range 10-42 months), two patients had died while 26 were alive and disease free. This method allows efficient in vivo purging in the context of an effective chemotherapy regimen and may have a role as first-line therapy in MCL patients who respond poorly to standard treatment.

Original languageEnglish
JournalBone Marrow Transplantation
Volume29
Issue numberSUPPL. 1
DOIs
Publication statusPublished - 2002

Fingerprint

Mantle-Cell Lymphoma
Stem Cell Transplantation
Drug Therapy
Melphalan
Leukapheresis
Polymerase Chain Reaction
Mitoxantrone
Neoplastic Stem Cells
Cytarabine
Residual Neoplasm
Non-Hodgkin's Lymphoma
Immunotherapy
Cyclophosphamide
Rituximab
Lymphoma
Stem Cells
Transplantation
Bone Marrow
Therapeutics
Neoplasms

Keywords

  • In vivo purging
  • Lymphoma
  • Rituximab
  • Stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Rituximab : Enhancing stem cell transplantation in mantle cell lymphoma. / Gianni, A. M.; Cortelazzo, S.; Magni, M.; Martelli, M.; Tarella, C.; Patti, K.; Pogliani, E.; Corradini, P.; Saglio, G.; Benedetti, F.

In: Bone Marrow Transplantation, Vol. 29, No. SUPPL. 1, 2002.

Research output: Contribution to journalArticle

Gianni, AM, Cortelazzo, S, Magni, M, Martelli, M, Tarella, C, Patti, K, Pogliani, E, Corradini, P, Saglio, G & Benedetti, F 2002, 'Rituximab: Enhancing stem cell transplantation in mantle cell lymphoma', Bone Marrow Transplantation, vol. 29, no. SUPPL. 1. https://doi.org/10.1038/sj/bmt/1703296
Gianni, A. M. ; Cortelazzo, S. ; Magni, M. ; Martelli, M. ; Tarella, C. ; Patti, K. ; Pogliani, E. ; Corradini, P. ; Saglio, G. ; Benedetti, F. / Rituximab : Enhancing stem cell transplantation in mantle cell lymphoma. In: Bone Marrow Transplantation. 2002 ; Vol. 29, No. SUPPL. 1.
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AB - Mantle cell lymphoma (MCL) responds poorly to standard chemotherapy regimens used in non-Hodgkin's lymphoma. As a result, a combination of high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) is being investigated in patients with MCL. So far, however, there is no evidence for longterm remission - believed, in part, to be due to contamination of the transfusion product with residual cancer cells. Many ex-vivo purging methods have been developed to remove tumour cells, but these are complicated, time-consuming and expensive. This study describes an in vivo purging method using rituximab to produce a tumour-free stem cell product for re-infusion following HDT. The regimen is split into a purging phase and a myeloablative phase, which together consist of four-step high-dose sequential chemotherapy (sHDT) and six infusions of rituximab immunotherapy. The sHDT comprises cyclophosphamide, cytosine arabinoside, melphalan and mitoxantrone plus melphalan. There are two separate stem cell harvests and three reinfusions. In a pilot study 28 patients with untreated MCL received standard chemotherapy followed by sHDT with rituximab in vivo purging. Preliminary results indicate that in PCR analyses of leukaphereses from 20 assessable patients, 100% lymphoma-negative harvests were achieved following in vivo purging. PCR analyses of the bone marrow following the four-step high-dose regimen with purging and transplantation showed that all patients achieved molecular remission. After a median follow-up of 22 months (range 10-42 months), two patients had died while 26 were alive and disease free. This method allows efficient in vivo purging in the context of an effective chemotherapy regimen and may have a role as first-line therapy in MCL patients who respond poorly to standard treatment.

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