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:
CreatorsEmailORCIDORCID Put Code
Kaddu-Mulindwa, DominicUNSPECIFIEDorcid.org/0000-0001-8832-252XUNSPECIFIED
Godel, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kutsch, NadineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heger, Jan-MichelUNSPECIFIEDorcid.org/0000-0001-9463-8504UNSPECIFIED
Scheid, ChristofUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borchmann, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Holtick, UdoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Held, GerhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thurner, LorenzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bewarder, MoritzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rixecker, TorbenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bittenbring, Joerg-ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
CHEMOTHERAPY PLUS RITUXIMAB; NON-HODGKIN-LYMPHOMA; TRIAL; REGIMENS; OUTCOMES; CHOPMultiple languages
Oncology; HematologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/67598

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