High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma

Authors

Hanan Alkhaldi
Alec Reinhardt
Melissa Barnett
Suprateek Kundu
Chitra Hosing
Jeremy Ramdial
Neeraj Saini
Samer Srour
Amin Alousi
Partow Kebriaei
Uday Popat
Muzaffar Qazilbash
Richard Champlin
Elizabeth J Shpall
Allison Gulbis
Terri Lynn Shigle
Bouthaina Dabaja
Chelsea Pinnix
Sairah Ahmed
Raphael Steiner
Borje S Andersson
Yago Nieto

Publication Date

11-1-2023

Journal

Transplantation and Cellular Therapy

DOI

10.1016/j.jtct.2023.08.019

PMID

37607645

Abstract

Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy with or without radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC), with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. The 60 study patients received either rituximab-BEAM (n = 37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) with or without vorinostat (n = 23), followed by ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range, .3 to 21 years), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group were 58% and 77%, respectively, for the entire cohort, 51% and 65% for the R-BEAM recipients, and 69% and 82% for R-vorinostat/GemBuMel recipients. Multivariable analyses showed that a negative positron emission tomography scan at ASCT (hazard ratio [HR], .28) and involvement of only 1 organ (HR, .33) were independently associated with improved PFS. In addition, receipt of R-vorinostat/GemBuMel (HR, .23) was an independent favorable predictor of OS. Our data indicate that HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.

Keywords

Adult, Humans, Hematopoietic Stem Cell Transplantation, Rituximab, Vorinostat, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols, Melphalan, Neoplasm Recurrence, Local, Transplantation, Autologous, Lymphoma, Large B-Cell, Diffuse, Thymus Neoplasms

Published Open-Access

yes

Recommended Citation

Alkhaldi, Hanan; Reinhardt, Alec; Barnett, Melissa; et al., "High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma" (2023). Faculty, Staff and Student Publications. 4665.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4665