Commentary on Abstracts #1173 and #2982

Publication
Article
OncologyONCOLOGY Vol 13 No 3
Volume 13
Issue 3

Allogeneic BMT has generally been limited to patients younger than age 50 to 55 years, and to those with good performance status and renal function. Several approaches are being evaluated to allow these poorer-risk patients to safely undergo transplantation. The successful use of submyeloablative (“mini”) transplants has previously been reported by groups from Israel (Slavin et al: Blood 91:756-73, 1998) and M. D. Anderson (Khouri et al: J Clin Oncol 16:2817-2824, 1998). A moderately myelosuppressive agent, such as cyclophosphamide (Cytoxan, Neosar), and an immunosuppressive drug, such as fludarabine (Fludara), are used as the preparative regimen. Following BMT, allogeneic donor leukocytes may be used to eliminate residual disease or mixed chimerism. Further study of this interesting approach is ongoing.

Allogeneic BMT has generally been limited to patients younger than age 50 to 55 years, and to those with good performance status and renal function. Several approaches are being evaluated to allow these poorer-risk patients to safely undergo transplantation. The successful use of submyeloablative (“mini”) transplants has previously been reported by groups from Israel (Slavin et al: Blood 91:756-73, 1998) and M. D. Anderson (Khouri et al: J Clin Oncol 16:2817-2824, 1998). A moderately myelosuppressive agent, such as cyclophosphamide (Cytoxan, Neosar), and an immunosuppressive drug, such as fludarabine (Fludara), are used as the preparative regimen. Following BMT, allogeneic donor leukocytes may be used to eliminate residual disease or mixed chimerism. Further study of this interesting approach is ongoing.

At the ASH meeting, Childs et al (abstract #1173) reported another approach for reducing transplant-related toxicity. They described their experience with T-cell–depleted allogeneic BMT, which permits older patients to undergo this procedure because of a reduction in graft-vs-host disease GVHD). The authors felt that their results supported preservation of the graft-vs-lymphoma (GVL) effect. This approach may also be applicable to patients undergoing an unrelated donor transplant, and infusions of small numbers of donor leukocytes could reduce the high incidence of severe opportunistic infections (Small et al: Blood 93:467-480, 1999).

Patients with indolent NHL may undergo a transformation to an aggressive, high-grade NHL. This event is usually accompanied by molecular findings of p53 mutations and clinical drug resistance. The only form of therapy that has been associated with a prolonged disease-free survival in these patients has been high-dose therapy with stem-cell support. Friedberg et al (abstract #2982) provide an update of their experience with autologous transplantation in 27 patients with follicular NHL whose tumors had undergone histologic transformation. The 5-year disease-free survival was 46% and overall survival was 58%. It is important to reinforce the point that, at transplantation, 12 patients had been reinduced into a complete remission and 15 had achieved a good partial response. These results confirm previous data that high-dose therapy with stem-cell support may benefit carefully selected patients whose NHL has undergone histologic transformation.

Articles in this issue

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma
Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma
Response Criteria for NHL: Importance of “Normal” Lymph Node Size and Correlations With Response
Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer
A Randomized Trial of Fludarabine, Mitoxantrone (FM) Versus Doxorubicin, Cyclophosphamide, Vindesine, Prednisone (CHEP) as First Line Treatment in Patients With Advanced Low-Grade Non-Hodgkin's Lymphoma: A Multicenter Study by GOELAMS Group
Navelbine Increased Elderly Lung Cancer Patients’ Survival
Fludarabine Versus Conventional CVP Chemotherapy in Newly C Diagnosed Patients With Stages III and IV Low-Grade Malignant Non-Hodgkin’s Lymphoma: Preliminary Results From a Prospective, Randomized Phase III Clinical Trial in 381 Patients
Multicenter, Phase III Study of Iodine-131 Tositumomab (Anti-B1 Antibody) for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma
T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma
Consensus Statement on Prevention and Early Diagnosis of Lung Cancer
In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL
Fludarabine and Cyclophosphamide: A Highly Active and Well-Tolerated Regimen for Patients With Previously Untreated Indolent Lymphomas
Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study
AIDS Drugs Effective Against Most Common HIV Strain
Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity
Related Videos
Although no responses were observed in 11 patients receiving abemaciclib monotherapy, combination therapies with abemaciclib may offer clinical benefit.
Stacey A. Cohen, MD, and Daniel H. Ahn, DO, presenting slides
Stacey A. Cohen, MD, and Daniel H. Ahn, DO, presenting slides
Findings show no difference in overall survival between various treatments for metastatic RCC previously managed with immunotherapy and TKIs.
An epigenomic profiling approach may help pick up the entire tumor burden, thereby assisting with detecting sarcomatoid features in those with RCC.
A panel of 4 experts on multiple myeloma
A panel of 4 experts on multiple myeloma
Cesar Rodriguez, MD, and Frits van Rhee, MD, PhD
Investigators are assessing the use of IORT in patients with borderline resectable or unresectable pancreatic cancer as part of the phase 2 PACER trial.
4 KOLs are featured in this panel.
Related Content