Tandem autologous stem cell transplantation in multiple myeloma after high-dose chemotherapy with two separate collections: single institution experience.

Presented is a retrospective analysis of multiple myeloma patients transplanted at our institution between November 1993 and August 2007. The objective of this analysis was to assess the feasibility and toxicity of tandem autologous stem cell transplantation (T-ASCT) when stem cells were harvested before first and before second transplantation separately. A total of 90 patients transplanted in our center were analyzed, of whom 43 patients were in tandem transplantation group.The overall response rate (ORR) was 83.7% and 95.1%, estimated five-year overall survival (OS) was 40.1% and 60.0%, probability of five-year event-free survival (EFS) was 18.2% and 25.6%, transplant related mortality (TRM) was 6.3% and 4.6% in the single and tandem transplant group, respectively. In multivariable analysis of all 90 patients, tandem transplantation and ORR attained after induction therapy were favourable prognostic factors for OS (p=0.024 and p=0.002) and EFS (p=0.036 and p=0.008), respectively. In conclusion, tandem transplantation with two separate stem cell harvests, performed separately before the each transplantation, is feasible in majority of patients with acceptable toxicity.

Autologous stem cell transplantation in first-line treatment of high-risk aggressive non-Hodgkin's lymphoma.

A single center, retrospective analysis evaluating the outcome of patients with poor-risk aggressive non-Hodgkin's lymphoma (NHL) treated with high-dose chemotherapy and autologous stem cell transplantation (ASCT) as a part of firstline therapy. Forty-seven patients younger than 65 years with diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), peripheral T-cell lymphoma (PTCL) or alk-negative anaplastic large cell lymphoma (ALCL) underwent ASCT between July 1997 and November 2005. Patients with DLBCL and alk-negative ALCL had 2 or 3 age-adjusted International Prognostic Index risk factors. All patients were transplanted after MACOP-B induction therapy followed by 2 courses of DHAP and myeloablative chemotherapy BEM or CBV. The complete response rate to the high-dose therapy was 79% with an estimated 5-year progression-free survival of 66%. At a median follow-up of 35 months (range, 16 to 112 months) the estimated overall survival at five years was 59%. There were 4 treatment-related deaths. Twenty-nine of 47 patients remain in complete remission. Our results confirm the efficacy of high-dose therapy with ASCT during first-line treatment of patients with poor-prognosis aggressive lymphoma, with substantial number of patients cured by using this treatment approach.

Autologous stem cell transplantation with selected CD34+ cells and unmanipulated peripheral blood stem cells in patients with relapsed and refractory Hodgkin's lymphoma: a single centre experience.

With the aim to evaluate the long term outcome after high-dose chemotherapy and autologous stem cell transplantation (HDCT+ASCT) in patients with relapsed or refractory Hodgkin's lymphoma (HL) we performed a retrospective analysis of patients transplanted at our centre. Between January 1993 and December 2005, 126 consecutive patients with relapsed or refractory HL in the age of 16 to 65 years underwent HDCT+ASCT at our centre and were enrolled in this retrospective analysis. Patients were autografted with either CD34+ positively selected or unmanipulated periferal blood stem cells (PBSC). With a median follow up of 69 months (3-162 months), the actuarial 5-y PFS and OS for all patients after HDCT+ASCT were 59% and 72%, respectively. In patients transplanted from 1996 the actuarial 5-y PFS and OS for CD34+ selected group were 64% and 79% and for unmanipulated PBSC group 63% and 66%, respectively. A total of 42/126 (33%) patients died. Treatment related mortality (TRM) was 3% (4 patients). In univariate analysis, chemosensitive disease and increased LDH were the strongest prognostic factors for PFS and OS. Our results confirm the efficacy of HDCT+ASCT in relapsed or refractory HL with acceptable toxicity. The use of CD34+ positively selected stem cells for autografting is feasible, safe and effective procedure.

Use of selected CD34+ cells in the treatment of relapsed/progressive HD: experiences from a single center.

BACKGROUND: Treatment of HD using positively selected stem cells can achieve a durable CR in almost 80% patients, with a median follow-up of 24 months. We have found the use of positive selected CD34+ cells in the treatment of relapsed/progressive HD after high-dose chemotherapy to be a safe procedure with promising results. METHODS: Positively selected (CD34+) stem cells were employed for autografting in the patients with HD after high-dose chemotherapy. RESULTS: Between April 1996 and February 2001, 28 patients with relapsed/progressive HD were autografted with positively selected CD34+ cells at our Institute. All patients are alive and we did not observe any deaths as a result of toxicity. From this group, 22 (78.6%) patients are in durable CR, with a median follow-up of 24 months (range 7-65 months). Six (21.4%) patients relapsed but are now in CR after radiotherapy and mini-allogeneic transplantation (one patient) or radiotherapy (five patients). DISCUSSION: Autologous transplantation with positively selected CD34+ cells in relapsed HD is a safe and effective procedure in the treatment of this disease.