Long term efficacy and safety of Fludarabine, Cyclophosphamide and Rituximab regimen followed by 90Y-ibritumomab tiuxetan consolidation for the treatment of relapsed grades 1 and 2 follicular lymphoma
Pisani F.,Regina Elena Cancer Institute |
Sciuto R.,Regina Elena Cancer Institute |
Dessanti M.L.,Unit of Hematology and Stem Cell Transplant |
Giannarelli D.,Italian National Cancer Institute |
And 4 more authors.
Experimental Hematology and Oncology | Year: 2015
Background: In this retrospective study, we investigated the efficacy and safety of radioimmunotherapy with 90Yttrium- ibritumomab tiuxetan (90Y-RIT) in 9 patients with recurrent follicular lymphoma (FL) who were treated in a consolidation setting after having achieved complete (CR) or partial remission (PR) with Fludarabine, Cyclophosphamide and Rituximab (FCR). Methods: The median age was 63years (range 46-77). All patients were relapsed with histologically confirmed CD20-positive (grade 1 or 2) FL, at relapse they received FCR every 28days: F (25mg/m2x 3days), C (1 gr/m2day 1) and R (375mg/m2day 4) for 4cycles. Those who achieved at least a PR with <25% bone marrow involvement were treated with 90Y-RIT 11.1 or 14.8MBq/Kg, at 3months after completing FCR. Patients underwent a further restaging at 12weeks after 90Y-RIT with a total body CT scan, FDG-PET/CT and bilateral bone marrow biopsy. Results: Nine patients completed the treatment: FCR followed by 90Y-RIT (6 patients at 14.8MBq/Kg, 3 patients at 11.1MBq/Kg). After FCR, 7 patients obtained CR and 2 PR; after 90Y-RIT 2 patients in PR converted to CR 12weeks later. With a median follow up of 95months (range 20-114) since FCR and 88months (range 13-104) since 90Y-RIT 3 deaths were not related to lymphoma; all 3 deceased patients obtained CR before 90Y-RIT and died still in CR. The median overall (OS) and progression free survival (PFS) have not been reached, in this analysis both OS or PFS are 67% at 7.5year. The most common grade 3 or 4 adverse events were hematologic. Conclusions: These results confirm the long term efficacy and safety of 4cycles of FCR followed by 90Y-RIT in relapsed grades 1 and 2 FL and suggest that this regimen could be a therapeutic option for this setting of patients, specially at age of 60-75 with no unexpected toxicities. 2015 © Pisani et al.
Girmenia C.,University of Rome La Sapienza |
Raiola A.M.,University of Genoa |
Piciocchi A.,GIMEMA Foundation |
Algarotti A.,Azienda Ospedaliera Papa Giovanni XXIII |
And 37 more authors.
Biology of Blood and Marrow Transplantation | Year: 2014
Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P < .0001). Our findings indicate that tailored prevention strategies may be useful in subpopulations at differing levels of risk for PP-IFDs. © 2014 American Society for Blood and Marrow Transplantation.