Stop-flow in mediastinum and thorax for resistant lymphoma

Stefano Guadagni, Filippo Russo, Giuseppe Abate, Tullio Pozone, Benita Capannolo, Luca Marsili, Valfredo D'Alessandro, Gianfranco Amicucci, Karl Roland Aigner

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: Management of patients with heavily pretreated malignant lymphoma failing frontline treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue, is problematic. A pilot study was conducted to evaluate isolated thoracic perfusion of drugs by means of stop-flow technique. Methodology: Six patients were enrolled in the study; diagnoses included 4 advanced Hodgkin's disease, 1 primary mediastinal B-cell lymphoma, and 1 anaplastic large cell lymphoma. Patients were aged 18-37 years; 4 presented with bulky mediastinum. They had never achieved a complete response since all had progressed from front-line treatment, and 3 had even failed salvage high-dose chemotherapy with autologous peripheral stem cell rescue. Cisplatin (100 mg/m2 and melphalan (35 mg/m2) were used. Carmustine (100 mg/m2) were added to these 2 drugs and cytarabine (2000 mg/m2) in patients not previously treated by carmustine, etoposide, cytarabine, and melphalan. Epidoxorubicin (70 mg/m2) was added in patients who previously received a suboptimal dosage of antracycline. Drugs were delivered monthly via aortic perfusion performed by means of Aigner's stop-flow technique. Results: Overall 13 cycles of perfusional chemotherapy were administered with a median number of 2 cycles. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. After 1 month, 6 (100%) objective responses after isolated thoracic perfusion were recorded, 3 (50%) of which were complete. Tolerance to therapy was excellent. Hematological toxicity was mild and transfusional support was needed only in one course. At the last follow-up, 2 patients are alive (1 complete response and 1 very good partial response, maintained). Conclusions: This new therapeutical approach seems very active in recurrent/refractory malignant lymphoma and may play an important role in this setting.

Original languageEnglish
Pages (from-to)378-382
Number of pages5
JournalHepato-Gastroenterology
Volume47
Issue number32
Publication statusPublished - 2000

Keywords

  • Lymphoma
  • Perfusion
  • Stopflow
  • Thorax

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint

Dive into the research topics of 'Stop-flow in mediastinum and thorax for resistant lymphoma'. Together they form a unique fingerprint.

Cite this