Dose-reduced busulfan, cyclophosphamide, and autologous stem cell transplantation for human immunodeficiency virus-associated lymphoma: AIDS Malignancy Consortium Study 020 Journal Article
| Authors: | Spitzer, T. R.; Ambinder, R. F.; Lee, J. Y.; Kaplan, L. D.; Wachsman, W.; Straus, D. J.; Aboulafia, D. M.; Scadden, D. T. |
| Article Title: | Dose-reduced busulfan, cyclophosphamide, and autologous stem cell transplantation for human immunodeficiency virus-associated lymphoma: AIDS Malignancy Consortium Study 020 |
| Abstract: | Intensive chemotherapy for human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) has resulted in durable remissions in a substantial proportion of patients. High-dose chemotherapy and autologous stem cell transplantation (AuSCT), moreover, has resulted in sustained complete remissions in selected patients with recurrent chemosensitive disease. Based on a favorable experience with dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT for older patients with non-HIV-associated aggressive lymphomas, an AIDS Malignancy Consortium multicenter trial was undertaken using the same dose-reduced busulfan and cyclophosphamide preparative regimen with AuSCT for recurrent HIV-associated NHL and HL. Of the 27 patients in the study, 20 received an AuSCT. The median time to achievement of an absolute neutrophil count (ANC) of ≥ 0.5×109/L was 11 days (range, 9-16 days). The median time to achievement of an unsupported platelet count of ≥ 20×109/L was 13 days (range, 6-57 days). One patient died on day +33 posttransplantation from hepatic veno-occlusive disease (VOD) and multiorgan failure. No other fatal regimen-related toxicity occurred. Ten of 19 patients (53%) were in complete remission at the time of their day +100 post-AuSCT evaluation. Of the 20 patients, 10 were alive and event-free at a median of 23 weeks post-AuSCT. Median overall survival (OS) was not reached by 13 of the 20 patients alive at the time of last follow-up. This multi-institutional trial demonstrates that a regimen of dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT is well tolerated and is associated with favorable disease-free survival (DFS) and OS probabilities for selected patients with HIV-associated NHL and HL. © 2008 American Society for Blood and Marrow Transplantation. |
| Keywords: | cancer survival; clinical article; controlled study; treatment outcome; disease-free survival; graft infection; overall survival; busulfan; clinical trial; drug tolerability; cancer recurrence; drug dose reduction; hypophosphatemia; patient selection; side effect; disease free survival; cytarabine; drug megadose; human immunodeficiency virus infection; follow up; disease association; controlled clinical trial; neutrophil count; pain; bleeding; stomatitis; antineoplastic combined chemotherapy protocols; cyclophosphamide; nucleoside analog; autologous stem cell transplantation; herpes simplex; pneumocystis pneumonia; hematopoietic stem cell transplantation; cancer mortality; hodgkin disease; time; febrile neutropenia; hyperuricemia; drug induced headache; hyperkalemia; hypermagnesemia; b cell lymphoma; cancer regression; nonhodgkin lymphoma; probability; multicenter study; thromboembolism; cd4+ t lymphocyte; lymphoma; urinary tract infection; graft versus host reaction; stem cell mobilization; transplantation conditioning; brain disease; thrombocyte count; single drug dose; nausea and vomiting; colitis; bacteremia; acquired immunodeficiency syndrome; seizure; antiretrovirus agent; highly active antiretroviral therapy; cd4 antigen; mesna; cotrimoxazole; granulocyte colony stimulating factor; mental health; proteinase inhibitor; transplantation, autologous; thrombotic thrombocytopenic purpura; lymphoma, aids-related; atovaquone; dapsone; fluconazole; cytomegalovirus infection; burkitt lymphoma; phenytoin; lymphocyte count; multiple organ failure; autologous peripheral blood stem cell transplantation; leukapheresis; liver venoocclusive disease; pharyngitis; defibrotide; pneumocystis carinii |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 14 |
| Issue: | 1 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-01-01 |
| Start Page: | 59 |
| End Page: | 66 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2007.03.014 |
| PUBMED: | 18158962 |
| PROVIDER: | scopus |
| PMCID: | PMC4524737 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 23" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus" |
