Matched-cohort analysis of autologous hematopoietic cell transplantation with radioimmunotherapy versus total body irradiation-based conditioning for poor-risk diffuse large cell lymphoma.

Abstract

We conducted a matched-cohort analysis of autologous transplant conditioning regimens for diffuse large cell lymphoma in 92 patients treated with either radioimmunotherapy (RIT) or total body irradiation (TBI)-based conditioning regimens. The RIT regimen consisted of 0.4 mCi/kg of (90)Y-ibritumomab tiuxetan plus BEAM (BCNU, etoposide, cytarabine, melphalan). The TBI-based regimen combined fractionated TBI at 1200 cGy, with etoposide and cyclophosphamide. Five factors were matched between 46 patient pairs: age at transplant ±5 years, disease status at salvage, number of prior regimens, year of diagnosis ±5 years, and year of transplantation ±5 years. Patients in the TBI group had higher rates of cardiac toxicity and mucositis, whereas Z-BEAM patients had a higher incidence of pulmonary toxicity. Overall survival at 4 years was 81.0% for the Z-BEAM and 52.7% for the TBI group (P = .01). The 4-year cumulative incidence of relapse/progression was 40.4% and 42.1% for Z-BEAM and TBI, respectively (P = .63). Nonrelapse mortality was superior in the Z-BEAM group: 0% compared with 15.8% for TBI at 4 years (P < .01). Our data demonstrate that RIT-based conditioning had a similar relapse incidence to TBI, with lower toxicity, resulting in improved overall survival, particularly in patients with ≥2 prior regimens.

• Authors: Amrita Krishnan, Joycelynne M Palmer, Ni-Chun Tsai, Jennifer R Simpson, Auayporn Nademanee, Andrew Raubitschek, Sandra H Thomas, Stephen J Forman
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 18 Issue 3 Pg. 441-50 (Mar 2012) ISSN: 1523-6536 [Electronic] United States
• PMID: 21801706 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Radiopharmaceuticals
• Rituximab
• ibritumomab tiuxetan

Topics

• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Cohort Studies
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Lymphoma, Large B-Cell, Diffuse (radiotherapy, surgery, therapy)
• Male
• Middle Aged
• Radioimmunotherapy (methods)
• Radiopharmaceuticals (therapeutic use)
• Rituximab
• Salvage Therapy (methods)
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Autologous
• Whole-Body Irradiation (adverse effects, methods)
• Young Adult