ABSTRACT
Only one-quarter to one-third of patients with relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL) treated with common salvage chemotherapy regimens and autologous stem cell transplant (ASCT) achieve 5-year progression-free survival (PFS). Worse outcomes have been reported after failure of prior rituximab-containing induction, initial time to progression (TTP) < 1 year or age-adjusted International Prognostic Index (aaIPI) = 2-3 at relapse. In Calgary, we have treated patients with r/r-aNHL with dose-intensive cyclophosphamide 5.25 g/m(2), etoposide 1.05 g/m(2) and cisplatin 105 mg/m(2) (DICEP) for both re-induction therapy and autologous blood stem cell mobilization. In this study we retrospectively analyzed 113 consecutive transplant-eligible patients with r/r-aNHL who received one cycle of DICEP (n = 93) or R-DICEP (n = 20) from 1995 to 2009. Patient characteristics included: median age = 49 years (22-69); TTP < 1 year = 85; elevated lactate dehydrogenase (LDH) = 60; Eastern Cooperative Oncology Group performance status (ECOG) 2-4 = 42; aaIPI 2-3 = 59; bulk > 10 cm = 26, prior rituximab = 27. The median number of CD34 + cells collected was 19 × 10(6)/kg (0.3-142), 83.5% responded and 90% (102) proceeded to ASCT. The 5-year PFS rate was 42% for all patients, 32% for those with relapse aaIPI = 2-3, 35% for initial TTP < 1 year and 56% for those who failed initial rituximab induction. In conclusion, (R)DICEP is an effective re-induction regimen for r/r-aNHL, leading to excellent stem cell mobilization, a high chance of proceeding to ASCT and encouraging long-term PFS rates.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cisplatin/adverse effects , Cisplatin/therapeutic use , Combined Modality Therapy , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Disease Progression , Etoposide/adverse effects , Etoposide/therapeutic use , Hematopoietic Stem Cell Transplantation , Humans , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/mortality , Lymphoma, Non-Hodgkin/therapy , Middle Aged , Recurrence , Salvage Therapy , Transplantation, Autologous , Treatment Outcome , Young AdultABSTRACT
CONCLUSIONS: Quality of life (QOL) scores were significantly higher among voice rehabilitated patients although this was accompanied by significant immediate and long-term morbidity and a cost implication for the patient. OBJECTIVE: We present a prospective and cross-over study of overall QOL and morbidity related to voice restoration in laryngectomees. METHODS: The EORTC QOL questionnaire (QLQ-C30 and QLQ-H&N-35) was distributed among all the consenting patients alive after laryngectomy from January 2008 to October 2009. In patients who had secondary voice rehabilitation, post-rehabilitation QOL scores were collected separately. Comparison of QOL between the non-rehabilitated and rehabilitated cohorts was done and a cross-over study of pre-rehabilitation and post-rehabilitation scores were done in the second cohort. RESULTS: A total of 113 patients were studied. QOL scores were significantly higher among voice rehabilitated patients.
