High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma

S. Lonial, T. W. Jones, S. Devine, E. F. Winton, L. T. Heffner, K. J. Smith, Andrew M Yeager, Edmund K. Waller

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Conventional dose combination chemotherapy for patients with relapsed or refractory lymphoma is rarely curative. High dose chemotherapy followed by hematopoietic progenitor cell transplant (HPCT) has a clearly defined role in patients who have first relapsed after standard CHOP chemotherapy for lymphoma. However, the role of HPCT is less well defined for patients with chemo-resistant, or chemo-refractory disease. Sixteen patients (15 Non-Hodgkin's, 1 Hodgkin's Disease) were entered into a phase II study to determine if a dose intensive induction regimen in heavily pre-treated refractory lymphoma patients could permit further consolidation with HPCT. The primary endpoints were survival, response, toxicity, and resource utilization. The regimen consisted of continuous infusion etoposide 1 or 2 gm/m2/72 hours, idarubicin 12 mg/m2/d for 3 days followed by cytarabine 2 gm/m2/72 hours on days 8,9, and 10 (VIC). Fifteen patients were evaluable for objective response. The overall response rate was 53% with 7 patients achieving a partial response and 1 patient achieving a complete response. Of the 8 responders, 6 patients subsequently received high dose chemotherapy followed by HPCT (4 autologous, 2 allogeneic). The median survival was 176 days for the non-responders contrasted with 722 days for the responders. The average duration of hospitalization was 38 days. Toxicity was mainfest primarily as mucositis with a median grade of 3 among the first 13 patients, and a median grade of 2 in three subsequent patients who received an etoposide dose of 1 gm/m2/72 hours. All patients had an episode of neutropenic fever and 5 patients developed clinically significant pneumonitis during therapy. The VIC regimen is active in the treatment of chemo-refractory lymphoma with clinically significant differences in survival for patients who respond to therapy. Further modifications to the regimen could include the addition of a topoisomerase I inhibitor for synergy with etoposide, and using VIC as part of a tandem transplant regimen where response to VIC would allow further therapy with a myeloablative induction followed by HPCT.

Original languageEnglish (US)
Pages (from-to)497-502
Number of pages6
JournalLeukemia and Lymphoma
Volume36
Issue number5-6
StatePublished - 2000
Externally publishedYes

Fingerprint

Lymphoma
Drug Therapy
Hematopoietic Stem Cells
Transplants
Therapeutics
Etoposide
Survival
Idarubicin
Topoisomerase I Inhibitors
Mucositis
Cytarabine
Combination Drug Therapy
Hodgkin Disease
Non-Hodgkin's Lymphoma
Pneumonia
Hospitalization
Fever

Keywords

  • High-dose chemotherapy
  • Lymphoma
  • Refractory

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Lonial, S., Jones, T. W., Devine, S., Winton, E. F., Heffner, L. T., Smith, K. J., ... Waller, E. K. (2000). High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma. Leukemia and Lymphoma, 36(5-6), 497-502.

High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma. / Lonial, S.; Jones, T. W.; Devine, S.; Winton, E. F.; Heffner, L. T.; Smith, K. J.; Yeager, Andrew M; Waller, Edmund K.

In: Leukemia and Lymphoma, Vol. 36, No. 5-6, 2000, p. 497-502.

Research output: Contribution to journalArticle

Lonial, S, Jones, TW, Devine, S, Winton, EF, Heffner, LT, Smith, KJ, Yeager, AM & Waller, EK 2000, 'High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma', Leukemia and Lymphoma, vol. 36, no. 5-6, pp. 497-502.
Lonial S, Jones TW, Devine S, Winton EF, Heffner LT, Smith KJ et al. High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma. Leukemia and Lymphoma. 2000;36(5-6):497-502.
Lonial, S. ; Jones, T. W. ; Devine, S. ; Winton, E. F. ; Heffner, L. T. ; Smith, K. J. ; Yeager, Andrew M ; Waller, Edmund K. / High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma. In: Leukemia and Lymphoma. 2000 ; Vol. 36, No. 5-6. pp. 497-502.
@article{2db5b3fa95534cbc84385cdcf5acd55d,
title = "High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma",
abstract = "Conventional dose combination chemotherapy for patients with relapsed or refractory lymphoma is rarely curative. High dose chemotherapy followed by hematopoietic progenitor cell transplant (HPCT) has a clearly defined role in patients who have first relapsed after standard CHOP chemotherapy for lymphoma. However, the role of HPCT is less well defined for patients with chemo-resistant, or chemo-refractory disease. Sixteen patients (15 Non-Hodgkin's, 1 Hodgkin's Disease) were entered into a phase II study to determine if a dose intensive induction regimen in heavily pre-treated refractory lymphoma patients could permit further consolidation with HPCT. The primary endpoints were survival, response, toxicity, and resource utilization. The regimen consisted of continuous infusion etoposide 1 or 2 gm/m2/72 hours, idarubicin 12 mg/m2/d for 3 days followed by cytarabine 2 gm/m2/72 hours on days 8,9, and 10 (VIC). Fifteen patients were evaluable for objective response. The overall response rate was 53{\%} with 7 patients achieving a partial response and 1 patient achieving a complete response. Of the 8 responders, 6 patients subsequently received high dose chemotherapy followed by HPCT (4 autologous, 2 allogeneic). The median survival was 176 days for the non-responders contrasted with 722 days for the responders. The average duration of hospitalization was 38 days. Toxicity was mainfest primarily as mucositis with a median grade of 3 among the first 13 patients, and a median grade of 2 in three subsequent patients who received an etoposide dose of 1 gm/m2/72 hours. All patients had an episode of neutropenic fever and 5 patients developed clinically significant pneumonitis during therapy. The VIC regimen is active in the treatment of chemo-refractory lymphoma with clinically significant differences in survival for patients who respond to therapy. Further modifications to the regimen could include the addition of a topoisomerase I inhibitor for synergy with etoposide, and using VIC as part of a tandem transplant regimen where response to VIC would allow further therapy with a myeloablative induction followed by HPCT.",
keywords = "High-dose chemotherapy, Lymphoma, Refractory",
author = "S. Lonial and Jones, {T. W.} and S. Devine and Winton, {E. F.} and Heffner, {L. T.} and Smith, {K. J.} and Yeager, {Andrew M} and Waller, {Edmund K.}",
year = "2000",
language = "English (US)",
volume = "36",
pages = "497--502",
journal = "Leukemia and Lymphoma",
issn = "1042-8194",
publisher = "Informa Healthcare",
number = "5-6",

}

TY - JOUR

T1 - High dose chemotherapy without hematopoietic cell support for the treatment of refractory lymphoma

AU - Lonial, S.

AU - Jones, T. W.

AU - Devine, S.

AU - Winton, E. F.

AU - Heffner, L. T.

AU - Smith, K. J.

AU - Yeager, Andrew M

AU - Waller, Edmund K.

PY - 2000

Y1 - 2000

N2 - Conventional dose combination chemotherapy for patients with relapsed or refractory lymphoma is rarely curative. High dose chemotherapy followed by hematopoietic progenitor cell transplant (HPCT) has a clearly defined role in patients who have first relapsed after standard CHOP chemotherapy for lymphoma. However, the role of HPCT is less well defined for patients with chemo-resistant, or chemo-refractory disease. Sixteen patients (15 Non-Hodgkin's, 1 Hodgkin's Disease) were entered into a phase II study to determine if a dose intensive induction regimen in heavily pre-treated refractory lymphoma patients could permit further consolidation with HPCT. The primary endpoints were survival, response, toxicity, and resource utilization. The regimen consisted of continuous infusion etoposide 1 or 2 gm/m2/72 hours, idarubicin 12 mg/m2/d for 3 days followed by cytarabine 2 gm/m2/72 hours on days 8,9, and 10 (VIC). Fifteen patients were evaluable for objective response. The overall response rate was 53% with 7 patients achieving a partial response and 1 patient achieving a complete response. Of the 8 responders, 6 patients subsequently received high dose chemotherapy followed by HPCT (4 autologous, 2 allogeneic). The median survival was 176 days for the non-responders contrasted with 722 days for the responders. The average duration of hospitalization was 38 days. Toxicity was mainfest primarily as mucositis with a median grade of 3 among the first 13 patients, and a median grade of 2 in three subsequent patients who received an etoposide dose of 1 gm/m2/72 hours. All patients had an episode of neutropenic fever and 5 patients developed clinically significant pneumonitis during therapy. The VIC regimen is active in the treatment of chemo-refractory lymphoma with clinically significant differences in survival for patients who respond to therapy. Further modifications to the regimen could include the addition of a topoisomerase I inhibitor for synergy with etoposide, and using VIC as part of a tandem transplant regimen where response to VIC would allow further therapy with a myeloablative induction followed by HPCT.

AB - Conventional dose combination chemotherapy for patients with relapsed or refractory lymphoma is rarely curative. High dose chemotherapy followed by hematopoietic progenitor cell transplant (HPCT) has a clearly defined role in patients who have first relapsed after standard CHOP chemotherapy for lymphoma. However, the role of HPCT is less well defined for patients with chemo-resistant, or chemo-refractory disease. Sixteen patients (15 Non-Hodgkin's, 1 Hodgkin's Disease) were entered into a phase II study to determine if a dose intensive induction regimen in heavily pre-treated refractory lymphoma patients could permit further consolidation with HPCT. The primary endpoints were survival, response, toxicity, and resource utilization. The regimen consisted of continuous infusion etoposide 1 or 2 gm/m2/72 hours, idarubicin 12 mg/m2/d for 3 days followed by cytarabine 2 gm/m2/72 hours on days 8,9, and 10 (VIC). Fifteen patients were evaluable for objective response. The overall response rate was 53% with 7 patients achieving a partial response and 1 patient achieving a complete response. Of the 8 responders, 6 patients subsequently received high dose chemotherapy followed by HPCT (4 autologous, 2 allogeneic). The median survival was 176 days for the non-responders contrasted with 722 days for the responders. The average duration of hospitalization was 38 days. Toxicity was mainfest primarily as mucositis with a median grade of 3 among the first 13 patients, and a median grade of 2 in three subsequent patients who received an etoposide dose of 1 gm/m2/72 hours. All patients had an episode of neutropenic fever and 5 patients developed clinically significant pneumonitis during therapy. The VIC regimen is active in the treatment of chemo-refractory lymphoma with clinically significant differences in survival for patients who respond to therapy. Further modifications to the regimen could include the addition of a topoisomerase I inhibitor for synergy with etoposide, and using VIC as part of a tandem transplant regimen where response to VIC would allow further therapy with a myeloablative induction followed by HPCT.

KW - High-dose chemotherapy

KW - Lymphoma

KW - Refractory

UR - http://www.scopus.com/inward/record.url?scp=0033952978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033952978&partnerID=8YFLogxK

M3 - Article

C2 - 10784394

AN - SCOPUS:0033952978

VL - 36

SP - 497

EP - 502

JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

IS - 5-6

ER -