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

Autologous pBSC transplantation for refractory or relapsed DBLCL Report of the « CNGMO, Tunis». 9 ème Congrès Magrébin d’Hématologie Dr Torjemane L 25/05/2012. Introduction.

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

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  1. AutologouspBSCtransplantation for refractory or relapsed DBLCL Report of the « CNGMO, 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 indicated in case of relapsed or refractory NHL. • From June 2000 to December 2011, a total of 28 autologous PSCT were performed at the « CNGMO »for DLCBCL in second line

  3. Patients & Methods(1)

  4. Transplant procedure • Conditioning regimen consisted in BEAM regimen (BICNU, Etoposid, Cytarabin, Melphalan) • Adjustment of dose of Melphalan (50%) to renalfunction: 2 patients • PBSC : 6,03 x106 CD34+/kg (range; 1,44- 13x106). (PBSC + Bone marrow : 2 patients)

  5. ResultsHematopoieticEngraftment • The mediansnumbers of days to reach: -Granulocytes > 500/mm3: 10 days ( range: 9 - 35) - Platelets ≥ 20 000/mm3: 15 days ( range; 12- 62) • Transfusion Requirements - RBC : 4 Units (range: 0- 19) - PCA: 6 Units (range: 2- 19)

  6. Transplant-relatedtoxicity • Stomatitis grade 3-4: 85% • Infectious complication: 100% - A median of 2 febrileneutropenia (range;1-4) - Pneumonia : n= 6, Abdominal pain - Septicemia (19%) : Gram + (n=6) Gram- (n=4) , Candida parapsilosis (n=2)

  7. Transplant-relatedtoxicity • Renaltoxicity (grade 1-2): n= 6 (21%) • Hepatictoxicity/VOD : n=1 (3,5%) • Cytomegalovirus Infections: n=4 (14%) • TreatmentrelatedMortality: n=2 (7%) ( Interstitiel Pneumonia + Septic choc)

  8. Therapeuticresults • At 3 monthsafter Transplants: - Complete Remission : 15/26 ( 58%) - Partial Remission: 8/26 (30%) - Resistantdisease: 3/26 (12 %) • Complementaryradiotherapy(2 resistantdiseases) : - 1 Complete Remission / negative TEP scanner - 1 Stable Partial Remission

  9. Therapeuticresults • Relapse rate: 10/26 (38%) • Mediandelai of relapse: 6 months (range; 3- 20) • After a median time of follow-up of 24 months, (range : 8- 120 months) 16 ( 57%) patients were alive and well.

  10. Overallsurvival, Cumulative Incidence of relapse and Event Free Survival OS at 3 years 50% CI Relapse 42% EFS at 3 years 53%

  11. EFS curvesaccordingpriorRituximabtreatment and disease statuts at transplant RC+RCu P= 0,2 RP

  12. Conclusion • The present results demonstrate the efficacy and moderatetoxicity of the HDC followed by autologous stem cell support in refractory or relapsedhigh-risk DLBCL • Addition of Rituximab significantly reduce the risk of relapse.

  13. 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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