1. Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine‐based high‐dose chemotherapy regimen
- Author
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Nicola Di Renzo, Paolo Di Carlo, Domenico Pastore, Nicola Cascavilla, Erminio Bonizzoni, Giuseppe Messina, Anna Mele, R. Matera, Potito Rosario Scalzulli, Chiara Ciochetto, Anxur Merenda, Antonello Pinto, Francesco Lanza, Vincenzo Pavone, Massimo Di Nicola, Maurizio Musso, Umberto Vitolo, Enrico Orciuolo, Stella Santarone, Renato Scalone, Gianpaolo Marcacci, Angelo Michele Carella, Daniela Donnarumma, Tiziana Moscato, and Alessandra Crescimanno
- Subjects
Male ,Oncology ,Melphalan ,Transplantation Conditioning ,autologous stem cell transplantation ,medicine.medical_treatment ,Salvage therapy ,Kaplan-Meier Estimate ,Nitrosourea Compounds ,0302 clinical medicine ,Autologous stem-cell transplantation ,Antineoplastic Combined Chemotherapy Protocols ,High-dose chemotherapy ,Medicine ,Prospective Studies ,Registries ,Child ,Etoposide ,Haematological Malignancy ,Graft Survival ,Cytarabine ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,fotemustine ,Hodgkin Disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,high‐dose chemotherapy ,Female ,Research Paper ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,NO ,Young Adult ,03 medical and health sciences ,Organophosphorus Compounds ,Internal medicine ,Humans ,Aged ,Salvage Therapy ,Chemotherapy ,business.industry ,Autologous stem cell transplantation ,Fotemustine ,Hodgkin lymphoma ,Drug Evaluation ,Positron-Emission Tomography ,Surgery ,Regimen ,business ,030215 immunology - Abstract
High-dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third-generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR-HL accrued into a prospective registry-based study. Application of FEAM resulted in a 2-year progression-free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64-0·81] with median PFS, overall survival and time to progression yet to be reached. The 2-year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12-0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose ((18) (F) FDG)-uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had (18) (F) FDG-positrin emission tomography-positive lesions before HDT, the 2-year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12-0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR-HL patients typically pre-exposed to lung-damaging treatments.
- Published
- 2015