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9 ème Congrès Magrébin d’Hématologie Dr Torjemane L 25/05/2012

Autologous peripheral stem cell transplantation for Diffuse Large B Cell Lymphoma ( dlbcl ) in first line: Report of the " CNGMO  " de Tunis. 9 ème Congrès Magrébin d’Hématologie Dr Torjemane L 25/05/2012. Introduction.

lisandra-chambers
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9 ème Congrès Magrébin d’Hématologie Dr Torjemane L 25/05/2012

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  1. Autologousperipheralstem cell transplantation for Diffuse Large B CellLymphoma (dlbcl) in first line:Report of the "CNGMO "de Tunis 9ème Congrès Magrébin d’Hématologie Dr Torjemane L 25/05/2012

  2. Introduction • High dose chemotherapy (HDC) followed by autologous peripheral stem cell transplantation (APSCT) is a part of therapeutic strategy: • National GELT 2002-2008 Protocol (Group 2B): • A subset of adult patients (aged of 16-60 years) with high risk (IPI≥2) DLBCL.

  3. Patients & Methods (1) From June 2000 to December 2011, a total of 122 autologous PSCT were performed at the CNGMO for NHL. A total of 72 patients , with DLBCL (IPI=2-3 ), were intensified in first line (partial or complete remission) Induction regimen: 4 ACVBP ± Rituximab + 2MTX

  4. Methods (2) Conditioning regimen: BEAM The meannumberof CD34+ cells : 6,15 x106 /kg (range; 1,9- 19,8) ( + BoneMarrow in one patient) The mean time[Induction - ASCT ] : 112 days(range; 74 - 158) The mean time [the 2nd MTX-ASCT]: 38 days (range; 20-107)

  5. ResultsHematopoieticEngraftment The meannumbers of days to reach: -Granulocytes > 500/mm3: 11 days ( range: 9 - 28) - Platelets ≥ 20 000/mm3: 12 days ( range; 9- 38) Transfusion Requirements: - RBC : 2 Units (range: 0- 10) - PCA : 3 Units (range: 0- 19)

  6. Transplant-related toxicity • Stomatitis grade 3-4: 50% • Infectious complications: - A mean of 1,58 febrileneutropenia (range; 0-4) - Pneumonia : (n= 5) , Cellulitis: (n=5) - Septicemia ( 14%) : Gram + (n=8) Gram – (n= 8) Candida parapsilosis (n=1)

  7. Transplant-related toxicity • Renaltoxicity (grade 1-2) : n= 3 (4%) • Livertoxicity (grade 1-2): n=3 (4%) • Cytomegalovirus Infections: n=3 (4%) • TreatmentrelatedMortality: 0

  8. Therapeutic Results (1) • At 3 months after APSCT, OverallResponse : 67/72 ( 93%) - Complete Remission (RC+Rcu) :53/72 ( 73,5 %) - Partial Remission : 14/72 (19,5%) - Progressive disease : 5/72 ( 7%) • Consolidative radiotherapy (CNS, residual mass): n=7

  9. Therapeutic Results (2) Relapse rate : 11/72(15%) - Mediandelai of 6 months (range; 1- 30 months) - Prior Rituximab: 5/11 (45%) After a median follow-up of 48months (range; 10- 118months), 61 (85%) patients were alive and well. PreservedFertility : age <35 years ( 5 pregnancy)

  10. Overall survival, Cumulative Incidence of relapse Event Free Survivall ( Kaplan-Meier) OS at 5 years =85% EFS at 5 years=82%

  11. Prognosis Factors

  12. EFS curves according Prognosis Factors RC+Rcu RP p<0,001

  13. Conclusion The present results demonstrate the efficacy and low toxicity of the HDC followed by autologous stem cell support in high-risk DLBCL Achievement of Complete Remission is the main prognostic factor. Addition of Rituximab significantly reduce the risk of relapse.

  14. THANKS Equipe d’Hhématologie de l’Hôpital HédiChaker, Sfax Equipe de Carcinologie Médicale de l’hôpital HédiChaker, Sfax Equipe d’Hématologie de l’hôpital FarhatHached, Sousse Equipe de Carcinologie Médicale de l’hôpital FarhatHached, Sousse Equipe d’Hématologie de l’Hôpital de Monastir Equipe d’Hématologie de l’Hôpital Aziza Othmana, Tunis Equipe d’Hématologie de l’Hôpital Militaire de Tunis Equipe de Carcinologie Médicale de l’Institut Salah Azaiez de Tunis Médecins Hématologues et Oncologues du Privé (Tunis, Sousse, Sfax)

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