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ctt-journal > Vorobyev et al. (Abstract)

Vorobyev et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract25

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Toxicity adapted high-dose therapy in mantle cell lymphoma patients, using the R-EPOCH, R-HMA, and R-GIDIOX schemes, and autologous stem cell transplantation

Vladimir I. Vorobyev1, Yuri Yu. Lorie1, Evgenii M. Gretsov1, Tatyana N. Obukhova1, Anait L. Melikjan1, Jana K. Mangasarova1, Anna A. Sidorova1, Dmitrii S. Mar'in1, Elena O. Gribanova1, Vera A. Zherebtsova2, Sergei K. Kravchenko1, Ivan A. Vorobyev1

1National Research Center for Hematology, Moscow, Russia; 2P.A. Herzen Moscow Oncological Research Institute, Moscow, Russia

Correspondence: Vladimir I. Vorobyev, National Research Center for Hematology, Novyi’ Zykovskii’ proezd 4a, Moscow, 125167 Russia, E-mail: morela@spam is badmail.ru

Abstract

Aim: Toxicity and efficacy assessment of the R-EPOCH/R-GIDIOX and R-EPOCH/R-HMA schemes in primary MCL patients eligible for autoSCT.

Methods: On May 2008 18 untreated MCL patients, average 55 years (29–63) were enrolled. After the first R-EPOCH cycle, patients were stratified according to the toxicity they had received, with either R-EPOCH/R-HD-Met-Ara-C (Romanguera J. 2005) or R-EPOCH/R-GIDIOX (gemcitabine 800 mg/m2 days 1 and 4, oxaliplatin 120 mg/m2 day 2, irinotecan 100 mg/m2 day 3, dexamethasone 10 mg/m2 IV days 1-5, ifosfamide 1000 mg/m2 days 1–5) for those who received higher hematological toxicity (grade 4 for more than 3 days) being administered. Depending on the terms of response, the patients received 6–8 cycles of chemotherapy and autoSCT (BEAM-R). Rituximab maintenance was performed every three months for 2 years.

Results: Thirty-three GIDIOX cycles were analyzed, with evidence that GIDIOX is a less intensive and toxic regimen than HMA, but in our selection the hematologic toxicity in the R-GIDIOX and R-HMA arms were similar due to less patients fitting into the R-GIDIOX arm. The main non-hematological toxicity of GIDIOX was hepatic, with elevated aminotransferases grades 1–2 and 3 in 55% and 2% of cycles respectively, without clinical signs. The sources of the stem cells were PB in 16 patients and BM in one case. Eight patients achieved CR (MRD-) from 9 in the HMA arm, with 1 induction death after the first HMA cycle (acute renal failure and septic shock), and one relapse 8 months after autoSCT, with observation from 4 to 17 months. The GIDIOX arm included 9 patients: OR 100%, 7 CR, 2 PR, with observation from 3 to 27 months, without relapses.

Conclusion: The GIDIOX scheme is less toxic than HMA and equally effective in response induction and mobilization, so it could be recommended for those in whom high-dose AraC and methotrexate can potentially cause severe adverse consequences.

Figure 1. Study design

Keywords: mantle cell lymphoma, autoSCT, gemcitabine, oxaliplatin, GIDIOX