Conditioning with treosulfan and fludarabine for patients with refractory or relapsed non‑Hodgkin lymphoma

Schmitt,Michael; Trenschel,Rudolf; Sayer,Herbert   G.; Schneider,Catarina; Glass,Aenne; Hilgendorf,Inken; Treschl,Anne; Junghanss,Christian; Borchert,Kersten; Koenigsmann,Michael; Casper,Jochen; Beelen,Dietrich  W.; Freund,Mathias; Kahl,Christoph

doi:10.3892/mco.2014.300

Conditioning with treosulfan and fludarabine for patients with refractory or relapsed non‑Hodgkin lymphoma

Authors:
- Michael Schmitt
- Rudolf Trenschel
- Herbert G. Sayer
- Catarina Schneider
- Aenne Glass
- Inken Hilgendorf
- Anne Treschl
- Christian Junghanss
- Kersten Borchert
- Michael Koenigsmann
- Jochen Casper
- Dietrich W. Beelen
- Mathias Freund
- Christoph Kahl
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Affiliations: Department of Internal Medicine III, University of Rostock, Rostock 18057, Germany, Department of Bone Marrow Transplantation, University of Duisburg‑Essen, Essen 45147, Germany, Department of Hematology and Oncology, University of Jena, Jena 07747, Germany, Institute for Biostatistics and Informatics in Medicine and Ageing Research, University of Rostock, Rostock 18057, Germany, Department of Hematology and Oncology, University of Magdeburg, Magdeburg 39120, Germany
Published online on: June 2, 2014 https://doi.org/10.3892/mco.2014.300
Pages: 773-782

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Abstract

The treatment of refractory or relapsed non‑Hodgkin lymphoma (NHL) remains challenging. In this retrospective study, 88 patients with refractory or relapsed NHL received treosulfan and fludarabine as a reduced‑intensity conditioning for allogeneic hematopoietic stem cell transplantation (allo‑HSCT). Of the 88 intensely pre‑treated patients, 73 experienced a relapse, with 18 of the 88 patients experiencing an early relapse (ER; <6 months from the last chemotherapy). At the time of allo‑HSCT, 26 patients were in complete remission (CR) and 43 in partial remission (PR), 12 patients had progressive disease (PD) and 7 had stable disease (SD). A total of 47 patients received an autologous graft followed by allo‑HSCT. Following allo‑HSCT, 69 of the 88 patients were in CR and 7 were in PR, resulting in an overall response rate of 86.4% (76/88). A total of 33 patients achieved a CR from PR, as did 6 patients from PD and 5 from SD. Of the 88 patients, 43 (49%) were alive at the end of the follow‑up period. The patients who directly underwent allo‑HSCT without prior auto‑HSCT exhibited a better disease‑free survival (DFS; P=0.038) with a tendency (P=0.077) for a better overall survival (OS). The patients with ER exhibited a probability of OS of 0.35±0.12 after 3 and 7 years. Chronic graft‑versus‑host disease (cGvHD) exerted a positive effect on OS and DFS (for limited cGvHD vs. no cGvHD, P=0.002 and 0.004, respectively). In conclusion, allogeneic stem cell transplantation following conditioning with treosufan and fludarabine constitutes a viable therapeutic option for patients with refractory or relapsed NHL and should be considered early during the course of salvage treatment.

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