Universität zu Köln

Kaddu-Mulindwa, Dominic ORCID: 0000-0001-8832-252X, Godel, Philipp, Kutsch, Nadine, Heger, Jan-Michel ORCID: 0000-0001-9463-8504, Scheid, Christof, Borchmann, Peter, Holtick, Udo, Held, Gerhard, Thurner, Lorenz, Bewarder, Moritz, Rixecker, Torben and Bittenbring, Joerg-Thomas (2022). Salvage High-dose Melphalan With Autologous Stem cell Transplantation as Bridge to Consolidation Therapy for Chemoresistant Aggressive B-cell Lymphoma. Clin. Lymphoma Myeloma Leuk., 22 (7). S. E498 - 9. DALLAS: CIG MEDIA GROUP, LP. ISSN 2152-2669

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Abstract

Background: Patients suffering from refractory aggressive B-cell lymphoma not responding to salvage chemotherapy have a dismal prognosis. CAR T-cells or allogeneic stem cell transplantation (SCT) are potentially curative approaches. However, obtaining a remission, and lowering tumor burden before consolidation seems crucial for long-term efficacy of both treatment modalities. Materials and Methods: In this retrospective analysis, we reviewed patients with chemoresistant aggressive B-cell lymphoma, defined as being refractory or progressive to at least second line salvage chemotherapy including the regimen immediately preceding autologous stem cell transplantation (ASCT), treated at 2 tertiary centers, who were eligible for intensive treatment using single agent high-dose (HD) melphalan to obtain a remission before consolidating therapy. Results: We identified 36 patients that received single agent HD melphalan and ASCT as remission induction followed by CAR T-cells or allogeneic stem cell transplantation (SCT). Thirteen of the evaluable patients (39.4%) achieved a partial remission and 9 patients (27.73%) a complete remission, resulting in an overall response rate (ORR) of 66.7%. High remission rates were seen across all subgroups including patients with primary refractory lymphoma (ORR 58.3%), uncontrolled disease and high tumor burden as indicated by increased LDH levels (ORR 66.7% for patients with elevated LDH above 2 times upper limit of norm). 22 patients proceeded to allogeneic SCT and 5 to CAR T-cell therapy. Treatment related mortality of ASCT was 5.5% (2 patients, both due to infections). Two-year overall survival of all patients was 15.8%, pr imar ily due to a high non-relapse mortality (45.5%) of allogeneic SCT patients treated with myeloablative conditioning chemotherapy. Conclusion: Single agent HD melphalan produces high remission rates in patients with chemoresistant, uncontrolled aggressive B-cell lymphoma and provides a window of opportunity for consolidation therapy.Microabstract: Patient with refractory/relapsed aggressive B-cell lymphoma after salvage therapy are an unmet medical need because of their very poor prognosis. In our retrospective analysis of 36 patients we showed that single agent high-dose melphalan can achieve high response rates (ORR 66.7%) even in uncontrolled disease enabling consolidation therapy e.g. with allogeneic stem cell transplantation or CAR T-cell therapy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kaddu-Mulindwa, Dominic UNSPECIFIED orcid.org/0000-0001-8832-252X UNSPECIFIED Godel, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Kutsch, Nadine UNSPECIFIED UNSPECIFIED UNSPECIFIED Heger, Jan-Michel UNSPECIFIED orcid.org/0000-0001-9463-8504 UNSPECIFIED Scheid, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Borchmann, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Holtick, Udo UNSPECIFIED UNSPECIFIED UNSPECIFIED Held, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Thurner, Lorenz UNSPECIFIED UNSPECIFIED UNSPECIFIED Bewarder, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED Rixecker, Torben UNSPECIFIED UNSPECIFIED UNSPECIFIED Bittenbring, Joerg-Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-675982
DOI:	10.1016/j.clml.2022.01.007
Journal or Publication Title:	Clin. Lymphoma Myeloma Leuk.
Volume:	22
Number:	7
Page Range:	S. E498 - 9
Date:	2022
Publisher:	CIG MEDIA GROUP, LP
Place of Publication:	DALLAS
ISSN:	2152-2669
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CHEMOTHERAPY PLUS RITUXIMAB; NON-HODGKIN-LYMPHOMA; TRIAL; REGIMENS; OUTCOMES; CHOP Multiple languages Oncology; Hematology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67598