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Posted by on Apr 18, 2018 in Hodgkin's lymphoma | 0 comments

In a nutshell

This study analyzed data from patients with Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) who received TECAM (etoposide, thiotepa, cytarabine, cyclophosphamide, melphalan) chemotherapy before autoSCT (autologous stem cell transplantation). The authors concluded that TECAM is an effective pre-autoSCT regimen for high-risk lymphoma patients.

Some background

High-dose chemotherapy followed by autologous stem cell transplantation (autoSCT, using stem cells from the patient) is the current standard for relapsed or hard-to-treat NHL and HL. Auto-SCT is needed after chemotherapy to restore the hematopoietic (blood-forming) cells in the bone marrow.

Conventional chemotherapy regimens include BEAM (carmustine, etoposide, cytarabine, melphalan) and CBV (cyclophosphamide, carmustine, etoposide). However, side effects from carmustine and poor survival outcomes limit their usage.

Alternative regimens that replace carmustine with other agents are being investigated to increase effectiveness and reduce side effects. One agent, thiotepa (Thioplex) has been used for non-lymphoma cancers with positive results. The long-term safety and effectiveness of thiotepa for lymphomas remains under investigation.

Methods & findings

This study involved 212 lymphoma patients. Of these, 34.9% had HL and 65.1% had NHL. The most common lymphoma subtype was diffuse large B-cell lymphoma (DLBCL; 25%). All patients received TECAM chemotherapy before stem cell transplantation. The average follow-up period was 2.84 years.

At 3 months post-transplant, 61.9% of patients were in CR and 4.1% of patients were in PR (partial remission). 19.72% of patients had disease progression.

At 3 years post-transplant, progression-free survival (time from treatment to either relapse or death) was 50% (HL) and 49% (DLBCL). Overall survival (time from transplant to death from any cause) was 61.8% (DLBCL) and 82.8% (HL). Non-relapse mortality (NRM; any death without relapse) was 2.8% for all patients.

During the study period, 50% of patients experienced mouth sores, either mild to moderate (38.7%) or severe (47.2%). 52% of patients required total parenteral nutrition (nutrition given via IV). 30% of patients had bacteremia (bacteria in the blood). 16% of patients experienced renal (kidney) failure. 4.7% of patients experienced septic shock (life-threateningly low blood pressure due to infection). 4.24% of patients developed secondary cancers.

During the study period, 35.8% of all patients died. Of these, 80.26% were due to relapse. 7.89% were due to secondary cancers. Another 7.89% were due to side effects, including infection (5.26%) and multi-organ failure (2.63%).

The bottom line

This study concluded that TECAM is an effective pre-ASCT regimen for high-risk lymphoma patients. The authors suggest that TECAM has fewer side effects compared to conventional regimens, such as BEAM.

The fine print

This study looked back in time to analyze data. As a result, the collected data may be incomplete. Also, because the patient population in this study had many lymphoma subtypes, only the most common types (DLBCL and HL) were included in the survival analysis. This may limit the conclusions that may be drawn. More studies are needed with a larger patient population to confirm these results.

Published By :

Clinical lymphoma, myeloma & leukemia

Date :

Feb 15, 2018

Original Title :

Thiotepa, Etoposide, Cyclophosphamide, Cytarabine, and Melphalan (TECAM) Conditioning Regimen for Autologous Stem Cell Transplantation in Lymphoma.

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