|
Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 18012
© 2008 American Society of Clinical Oncology
Maintenance immunotherapy after autologous bone marrow transplantation (ABMT) in relapsed follicular (R-FL) and mantle cell (R-MC) lymphomas (NHL). A monoinstitutional experience
M. Rupolo,
M. Michieli,
R. Manuele,
M. Spina,
P. Bulian,
M. Degan,
M. Mazzucato,
L. Abbruzzese and
U. Tirelli
CRO Aviano, IRCCS, Aviano, Italy
18012
Background: Recent evidences supported the benefit of Rituxan in combination with chemotherapy in CD20+ NHL. Further maintenance therapy with Rituxan resulted in improved event free survival in R-FL and R-MC NHL. In this study we assessed the tolerability and the activity in terms of clinical and molecular remission of Rituxan after ABMT in R-FL or R-MC NHL. Methods: The pts in response after salvage treatment (R-DHAOX) underwent to high dose chemotherapy (HDC) with the scheme BEAM-R and further were treated with maintenance therapy with rituximab 375 mg/m2 i.v. day +75 from ABMT. After 3 monthly doses, pts were treated with further 5 every 4 months (for a total of 2 years). During immunotherapy intravenous immuglobulins (IVIG) were infused if the seric concentration of IgG was lower than normal value. Results: From June 2002 to January 2007, 34 pts were enrolled. 21 were male (M) and 13 female (F). Median age was 51 (30–66). 23 ( 68%) pts were R-FL G1-G2, 10 (29%) R-MC and 1 a transformed follicular (TF). The stage was III for 8 (24%) and IV for 26 (76%) pts. 24 (70%) pts were previous treated with rituxan and 32 (94%) with anthracyclines schedules. CD34+ harvest was after 4th cycle with a median collection of 5,5 x106/Kg (2,1–20); 2 were positive for BCL-2 and 1 for BCL-1. Overall clinical response before ABMT was 91% for R-FL and 80% for R-MC. 29 pts (85%) underwent ABMT with the schedule BEAM-R. At the time of relapse 52% (12/23) of R-FL and 1 TF were BCL-2 positive while 60% (6/10) of R-MC for BCL-1. Before ABMT 5/19 pts (4 R-FL and 1 FT) were BCL-2 positive and 1/10 for BCL-1. 3 R-FL and 1 FT relapsed after ABMT: 2 with re-expression of BCL-2 and 2 without; 2 pts relapsed among R-MC, all negative for BCL-1. No pt showed severe or fatal infections during maintenance immunotherapy. After a median follow up of 32 months (mo) from salvage therapy (range 0.3–66.8 mo) 5-yrs projected PFS was 72% for R-MC and 78% for R-FL respectively and 5-yrs projected OS was 100% for R-ML an 82% for R-FL respectively. Conclusions: These data suggested that the use of rituxan in combination with HDC is an effective in vivo purging method. HDC and maintenance immunotherapy with rituxan is an approach well tolerated and highly effective for R-FL and R-MC NHL.
No significant financial relationships to disclose.
|
