AUTOLOGOUS PBSC TRANSPLANTATION
FOR REFRACTORY OR RELAPSED DBLCL
REPORT OF THE « CNGMO, TUNIS»
9ème Congrès Magrébin d’Hématologie
Dr Torjemane L
25/05/2012
Introduction
• High dose chemotherapy (HDC) followed by
autologous peripheral stem cell transplantation
(APSCT) is indicated in case of relapsed or refractory
NHL.
• From June 2000 to December 2011, a total of 28
autologous PSCT were performed at the « CNGMO »
for DLCBCL in second line
Patients & Methods(1)
Carateristics at diagnosis
Median age
Sexe ratio (M/F)
Number
40 years (range; 18-54 years)
20/8 (2,5)
Histological subtype
Diffuse LBCL
Richter
26
2
Stage I-II
III-IV
6
22
IPIaa
9
19
12
3
0-1
2-3
Bulky disease
BM involvement
Treatments & Responses
Initial Treatment regimen
CHOP (± radiotherapy)
ACVBP
Others
Number
9 (4)
15
4
Response for first line therapy
Refractory
Relapsed NHL
Median time of relapse (range)
11
17
12 months (2-84)
Salvage therapy (Heterogenous)
1 line
2 to 3 lines
+ Rituximab
+ Radiotherapy
22
5&1
18
2
Caracteristics of patients
Number
at transplant
Disease Status
Complete Remission (CR + Cru)
18 ( 64%)
Partial remission
10 (39%)
Resistant disease
2 (7%)
Bulky (Tumor size >7cm)
5
Median time, (range)
Last chemotherapy –ASCT
Diagnosis- ASCT
34 days (21-120)
21 months (5-122)
Transplant procedure
•
Conditioning regimen consisted in BEAM regimen
(BICNU, Etoposid, Cytarabin, Melphalan)
• Adjustment of dose of Melphalan (50%) to renal
function: 2 patients
•
PBSC : 6,03 x106 CD34+/kg (range; 1,44- 13 x106).
(PBSC + Bone marrow : 2 patients)
Results
Hematopoietic Engraftment
• The medians numbers of days to reach:
-Granulocytes > 500/mm3: 10 days ( range: 9 - 35)
- Platelets ≥ 20 000/mm3: 15 days
•
Transfusion Requirements
- RBC : 4 Units (range: 0- 19)
- PCA: 6 Units (range: 2- 19)
( range; 12- 62)
Transplant-related toxicity
o Stomatitis grade 3-4:
85%
o Infectious complication:
100%
- A median of 2 febrile neutropenia (range;1-4)
- Pneumonia : n= 6, Abdominal pain
- Septicemia (19%) :
Gram + (n=6)
Gram- (n=4)
,
Candida parapsilosis (n=2)
Transplant-related
toxicity
o Renal toxicity (grade 1-2): n= 6 (21%)
o Hepatic toxicity/VOD : n=1 (3,5%)
o Cytomegalovirus Infections: n=4 (14%)
o Treatment related Mortality: n=2 (7%)
( Interstitiel Pneumonia + Septic choc)
Therapeutic results
• At 3 months after Transplants:
- Complete Remission : 15/26
( 58%)
- Partial Remission:
8/26
(30%)
- Resistant disease:
3/26
(12 %)
• Complementary radiotherapy (2 resistant diseases) :
- 1 Complete Remission / negative TEP scanner
- 1 Stable Partial Remission
Therapeutic results
• Relapse rate: 10/26
(38%)
• Median delai of relapse: 6 months (range; 3- 20)
• After a median time of follow-up of 24 months,
(range : 8- 120 months) 16 ( 57%) patients were
alive and well.
Overall survival, Cumulative Incidence of
relapse and Event Free Survival
1
0.8
OS at 3 years 50%
0.8
0.7
0.6
0.6
CI Relapse 42%
0.5
0.4
0.4
0.3
0.2
0.2
0.1
0
0
20
40
60
80
100
120
0
140
0
Temps1
20
40
60
80
1
0.8
EFS at 3 years 53%
0.6
0.4
0.2
0
0
20
40
60
5
80
100
120
140
100
120
140
EFS curves according prior Rituximab
treatment and disease statuts at transplant
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1
0.9
0.8
Rituxi;ab +
0.7
0.6
0.5
Rituxi;ab -
0.4
p= 0,026
0.3
0.2
0.1
0
0
20
40
60
80
120
140
P= 0,2
RP
0
20
40
60
Temps1
Temps1
0
100
RC+RCu
1
1
0
80
Conclusion
• The present results demonstrate the efficacy
and moderate toxicity of the HDC followed
by autologous stem cell support in
refractory or relapsed high-risk DLBCL
• Addition of Rituximab significantly reduce
the risk of relapse.
THANKS
• Equipe d’Hhématologie de l’Hôpital Hédi Chaker, Sfax
• Equipe de Carcinologie Médicale de l’hôpital Hédi
Chaker, Sfax
• Equipe d’Hématologie de l’hôpital Farhat Hached, Sousse
• Equipe de Carcinologie Médicale de l’hôpital Farhat
Hached, Sousse
• Equipe d’Hématologie de l’Hôpital de Monastir
• Equipe d’Hématologie de l’Hôpital Aziza Othmana, Tunis
• Equipe d’Hématologie de l’Hôpital Militaire de Tunis
• Equipe de Carcinologie Médicale de l’Institut Salah Azaiez
de Tunis
• Médecins Hématologues et Oncologues du Privé (Tunis,
Sousse, Sfax)