Novel Salvage Regimen Helps Bridge to Stem-Cell Transplantation in Lymphoid Malignancies

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(ChemotherapyAdvisor) – A novel regimen that adds fludarabine to dose-adjusted continuous-infusion etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin with or without rituximab provides tumor cytoreduction and lymphocyte depletion (DA-EPOCH-F/R), offering a bridge to reduced-intensity allogeneic hematopoietic stem-cell transplantation (RIC-alloHSCT) in patients with aggressive lymphoid malignancies, a study published in the Journal of Clinical Oncology online February 6 concluded.

Currently, no standard chemotherapy regimen exists for patients with lymphoid malignancies being considered for RIC-alloHSCT. Michael R. Bishop, MD, of the Medical College of Wisconsin Clinical Cancer Center, Milwaukee, WI, administered the DA-EPOCH-F/R regimen to 147 patients with lymphoid malignancy for one to three consecutive cycles until lymphocyte depletion or disease progression. Median age was 50 years. Patients had received a median of three prior regimens, and 47% had chemo-refractory disease.

The regimen resulted in lymphocyte depletion (P<0.001), which was found to be inversely related to levels of serum interleukin 7 and 15. A total of 143 patients proceeded to RIC-alloHSCT. Those with lower CD3+, CD4+, and CD8+ T-cell counts after DA-EPOCH-F/R “were more likely to achieve full donor lymphoid chimerism by day +14 after transplant,” the investigators noted.

Overall response rate was 41%; 39% had stable disease. Patients who had complete and partial response had increased event-free survival, 77.4 vs 4.8 months (P<0.001) and overall survival, 98.5 vs. 16.2 months (P<0.001), relative to nonresponders to the DA-EPOCH-F/R regimen.


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