IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)?

Richard S. Stein, John P. Greer, Stacey A. Goodman, Stephen J. Brandt, David S. Morgan, William R. Macon, Thomas L. McCurley, Steven N. Wolff

Research output: Contribution to journalArticle

Abstract

While autologous transplantation has been used extensively in patients with relapsed and refractory NHL, little information is available regarding the optimal preparative regimen. Between 9/86 and 6/98,157 patients with low grade (N=36), intermediate grade (N=99), or high grade (N=22) lymphoma underwent autologous transplantation at a single institution. Two preparative regimens were used. The intensified preparative regimen used in all patients eligible to receive total body irradiation (TBI) was etoposide 1800 mg/m2 by continuous infusion over 26 hours, starling day -7, cyclophosphamide 150 mg/kg total dose (50 mg/kg, over 2 hours, day -6, -5, and -4), and total body irradiation, 5 or 6 fractions of 200 cGy each, delivered on day -3, -2, and -1 (C Y-VP-TBI) (N= 110). Patients who had received extensive prior radiotherapy, and who could not receive total body irradiation, as well as most patients over the age of 55, received etoposide 2400 mg/m2 by continuous infusion over 34 hours, starting day -7, cyclophosphamide 1800 mg/m2 day -6. -5, -4, and -3, and BCNU 400 mg/ m2 day -2 (CBV) (N=47). The two groups were not significantly different with respect to source of stem cells, gender, stage at presentation, incidence of prior bone marrow involvement, sensitivity to salvage therapy, or histologie grade of lymphoma. The CBV group was significantly older, 49% of patients over age 50, as compared to 26% of patients over age 50 for the CY-VP-TBI group, p<.001. Response rates and the incidence of fatal toxicity were similar for the two groups. Five year actuarial survival was 31% + 9% for CBV and 38% + 5% for CY-VP-TBI, p =.85. In a multivariate analysis, in which preparative regimen, age, histologie grade of lymphoma, and sensitivity to salvage therapy were the independent variables, TBI was not significantly associated with survival, and the direction of the trend was for TBI to be less effective than CBV. TBI does not appear to be an essential component of preparative therapy for autologous transplantation in patients with lymphoma as long as the regimen which is used is appropriately dose intense.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART II
StatePublished - 2000
Externally publishedYes

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Autologous Transplantation
Whole-Body Irradiation
Non-Hodgkin's Lymphoma
Irradiation
Lymphoma
Salvaging
Salvage Therapy
Therapeutics
Etoposide
Cyclophosphamide
Starlings
Carmustine
Survival
Incidence
Radiotherapy
Stem cells
Refractory materials
Toxicity
Bone
Stem Cells

ASJC Scopus subject areas

  • Hematology

Cite this

Stein, R. S., Greer, J. P., Goodman, S. A., Brandt, S. J., Morgan, D. S., Macon, W. R., ... Wolff, S. N. (2000). IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)? Blood, 96(11 PART II).

IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)? / Stein, Richard S.; Greer, John P.; Goodman, Stacey A.; Brandt, Stephen J.; Morgan, David S.; Macon, William R.; McCurley, Thomas L.; Wolff, Steven N.

In: Blood, Vol. 96, No. 11 PART II, 2000.

Research output: Contribution to journalArticle

Stein, RS, Greer, JP, Goodman, SA, Brandt, SJ, Morgan, DS, Macon, WR, McCurley, TL & Wolff, SN 2000, 'IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)?', Blood, vol. 96, no. 11 PART II.
Stein, Richard S. ; Greer, John P. ; Goodman, Stacey A. ; Brandt, Stephen J. ; Morgan, David S. ; Macon, William R. ; McCurley, Thomas L. ; Wolff, Steven N. / IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)?. In: Blood. 2000 ; Vol. 96, No. 11 PART II.
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title = "IS total body irradiation (tbi) a necessary component of preparative therapy for autologous transplantation in non-hodgkin's lymphoma (NHL)?",
abstract = "While autologous transplantation has been used extensively in patients with relapsed and refractory NHL, little information is available regarding the optimal preparative regimen. Between 9/86 and 6/98,157 patients with low grade (N=36), intermediate grade (N=99), or high grade (N=22) lymphoma underwent autologous transplantation at a single institution. Two preparative regimens were used. The intensified preparative regimen used in all patients eligible to receive total body irradiation (TBI) was etoposide 1800 mg/m2 by continuous infusion over 26 hours, starling day -7, cyclophosphamide 150 mg/kg total dose (50 mg/kg, over 2 hours, day -6, -5, and -4), and total body irradiation, 5 or 6 fractions of 200 cGy each, delivered on day -3, -2, and -1 (C Y-VP-TBI) (N= 110). Patients who had received extensive prior radiotherapy, and who could not receive total body irradiation, as well as most patients over the age of 55, received etoposide 2400 mg/m2 by continuous infusion over 34 hours, starting day -7, cyclophosphamide 1800 mg/m2 day -6. -5, -4, and -3, and BCNU 400 mg/ m2 day -2 (CBV) (N=47). The two groups were not significantly different with respect to source of stem cells, gender, stage at presentation, incidence of prior bone marrow involvement, sensitivity to salvage therapy, or histologie grade of lymphoma. The CBV group was significantly older, 49{\%} of patients over age 50, as compared to 26{\%} of patients over age 50 for the CY-VP-TBI group, p<.001. Response rates and the incidence of fatal toxicity were similar for the two groups. Five year actuarial survival was 31{\%} + 9{\%} for CBV and 38{\%} + 5{\%} for CY-VP-TBI, p =.85. In a multivariate analysis, in which preparative regimen, age, histologie grade of lymphoma, and sensitivity to salvage therapy were the independent variables, TBI was not significantly associated with survival, and the direction of the trend was for TBI to be less effective than CBV. TBI does not appear to be an essential component of preparative therapy for autologous transplantation in patients with lymphoma as long as the regimen which is used is appropriately dose intense.",
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AU - Stein, Richard S.

AU - Greer, John P.

AU - Goodman, Stacey A.

AU - Brandt, Stephen J.

AU - Morgan, David S.

AU - Macon, William R.

AU - McCurley, Thomas L.

AU - Wolff, Steven N.

PY - 2000

Y1 - 2000

N2 - While autologous transplantation has been used extensively in patients with relapsed and refractory NHL, little information is available regarding the optimal preparative regimen. Between 9/86 and 6/98,157 patients with low grade (N=36), intermediate grade (N=99), or high grade (N=22) lymphoma underwent autologous transplantation at a single institution. Two preparative regimens were used. The intensified preparative regimen used in all patients eligible to receive total body irradiation (TBI) was etoposide 1800 mg/m2 by continuous infusion over 26 hours, starling day -7, cyclophosphamide 150 mg/kg total dose (50 mg/kg, over 2 hours, day -6, -5, and -4), and total body irradiation, 5 or 6 fractions of 200 cGy each, delivered on day -3, -2, and -1 (C Y-VP-TBI) (N= 110). Patients who had received extensive prior radiotherapy, and who could not receive total body irradiation, as well as most patients over the age of 55, received etoposide 2400 mg/m2 by continuous infusion over 34 hours, starting day -7, cyclophosphamide 1800 mg/m2 day -6. -5, -4, and -3, and BCNU 400 mg/ m2 day -2 (CBV) (N=47). The two groups were not significantly different with respect to source of stem cells, gender, stage at presentation, incidence of prior bone marrow involvement, sensitivity to salvage therapy, or histologie grade of lymphoma. The CBV group was significantly older, 49% of patients over age 50, as compared to 26% of patients over age 50 for the CY-VP-TBI group, p<.001. Response rates and the incidence of fatal toxicity were similar for the two groups. Five year actuarial survival was 31% + 9% for CBV and 38% + 5% for CY-VP-TBI, p =.85. In a multivariate analysis, in which preparative regimen, age, histologie grade of lymphoma, and sensitivity to salvage therapy were the independent variables, TBI was not significantly associated with survival, and the direction of the trend was for TBI to be less effective than CBV. TBI does not appear to be an essential component of preparative therapy for autologous transplantation in patients with lymphoma as long as the regimen which is used is appropriately dose intense.

AB - While autologous transplantation has been used extensively in patients with relapsed and refractory NHL, little information is available regarding the optimal preparative regimen. Between 9/86 and 6/98,157 patients with low grade (N=36), intermediate grade (N=99), or high grade (N=22) lymphoma underwent autologous transplantation at a single institution. Two preparative regimens were used. The intensified preparative regimen used in all patients eligible to receive total body irradiation (TBI) was etoposide 1800 mg/m2 by continuous infusion over 26 hours, starling day -7, cyclophosphamide 150 mg/kg total dose (50 mg/kg, over 2 hours, day -6, -5, and -4), and total body irradiation, 5 or 6 fractions of 200 cGy each, delivered on day -3, -2, and -1 (C Y-VP-TBI) (N= 110). Patients who had received extensive prior radiotherapy, and who could not receive total body irradiation, as well as most patients over the age of 55, received etoposide 2400 mg/m2 by continuous infusion over 34 hours, starting day -7, cyclophosphamide 1800 mg/m2 day -6. -5, -4, and -3, and BCNU 400 mg/ m2 day -2 (CBV) (N=47). The two groups were not significantly different with respect to source of stem cells, gender, stage at presentation, incidence of prior bone marrow involvement, sensitivity to salvage therapy, or histologie grade of lymphoma. The CBV group was significantly older, 49% of patients over age 50, as compared to 26% of patients over age 50 for the CY-VP-TBI group, p<.001. Response rates and the incidence of fatal toxicity were similar for the two groups. Five year actuarial survival was 31% + 9% for CBV and 38% + 5% for CY-VP-TBI, p =.85. In a multivariate analysis, in which preparative regimen, age, histologie grade of lymphoma, and sensitivity to salvage therapy were the independent variables, TBI was not significantly associated with survival, and the direction of the trend was for TBI to be less effective than CBV. TBI does not appear to be an essential component of preparative therapy for autologous transplantation in patients with lymphoma as long as the regimen which is used is appropriately dose intense.

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