Autologous blood stem cell transplantation for Hodgkin and non-Hodgkin lymphoma: Complications and outcome.
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Date
2010-11
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Abstract
Background. We analysed data on patients of Hodgkin
and non-Hodgkin lymphoma treated with high dose
chemotherapy followed by autologous stem cell transplantation
to determine the toxicity, pattern of infections and long term
outcome.
Methods. There were 34 male and 10 female patients
(median age 35 years, range 15–67 years). Before transplantation,
31 patients (70.5%) had chemosensitive disease and
13 (29.5%) had chemoresistant disease. Granulocyte-colony
stimulating factor mobilized peripheral blood stem cells were
used as the source of stem cells. The patients received high dose
chemotherapy using CBV (cyclophosphamide, BCNU and VP-
16 [etoposide] n=38), BEAM (BCNU, etoposide, cytosine
arabinoside and melphalan, n=3), cytosine arabinoside,
etoposide and melphalan (n=2) and melphalan alone (n=1).
Prophylaxis with antifungal drugs (fluconazole/itraconazole)
and acyclovir was used.
Results. Following transplant, 32 patients (72.7%)
responded; complete response was achieved in 25 patients
(56.8%) and partial response in 7 (15.9%). The rate of
complete response was higher for patients with pre-transplant
chemosensitive disease (23/31 [74.2%] v. 2/13 [15.4%],
p<0.001). Gastrointestinal toxicity, and renal and liver dysfunctions
were major non-haematological toxicities; 3 patients
(7%) died of regimen-related toxicity. Infections (predominantly
Gram-negative) accounted for 2 deaths (4.5%) seen
before day 30. At a median follow up of 79 months (range
14–168 months), median overall and event-free survival
were 78 months and 28 months, respectively. Estimated
mean (SE) overall and event-free survival at 60 months were 54.34% (0.07) and 34.3% (9.88), respectively.
Conclusion. Patients with pre-transplant chemosensitive disease and those who achieved complete response following transplant had a significantly better chance of survival.
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Kumar Lalit, Ganessan Prasanth, Ghosh Indraneel, Panda Deepanjan, Gogia Ajay, Mandhania Sushil. Autologous blood stem cell transplantation for Hodgkin and non-Hodgkin lymphoma: Complications and outcome. National Medical Journal of India. 2010 Nov-Dec; 23(6): 330-335.