Radioimmunotherapy for stem cell transplantation in non-Hodgkin's lymphoma

in pursuit of a complete response.

Christian Gisselbrecht, Julie Marie Vose, Auayporn Nademanee, Alessandro M. Gianni, Arnon Nagler

Research output: Contribution to journalReview article

30 Citations (Scopus)

Abstract

High-dose chemotherapy (HDC) conditioning given in association with autologous stem cell transplantation (ASCT) or reduced-intensity conditioning (RIC) with allogeneic stem cell transplantation (alloSCT) are established treatment approaches for patients with chemotherapy-sensitive, relapsed, aggressive, or low-grade non-Hodgkin's lymphoma (NHL). These approaches have been shown to be the only curative option for patients with relapsed NHL. Despite data suggesting that prolonged event-free survival can be achieved with SCT combined with HDC, there are problems that may limit the utility of this approach for a broad patient population. For example, older patients, who make up the majority of the NHL population, may not be able to withstand the toxicities associated with this intensive regimen, and this therapy combination, especially when it includes the use of total-body irradiation, has been associated with a greater risk for secondary malignancies. Furthermore, relapse is the most common cause of treatment failure after HDC with ASCT and there is a poor success rate for those patients with either chemotherapy-refractory or heavily pretreated, multiple-relapsed disease. Consequently, there is an urgent need for other effective and well-tolerated approaches that will eradicate the residual disease that may persist before SCT, thus improving outcomes for patients with this life-threatening disease. In addition, approaches with better safety profiles would allow older patients to benefit from this therapeutic option. Because lymphomas are highly sensitive to radiation, radioimmunotherapy (RIT) has been used with great success in consolidation therapy and, as a result, there is great interest in exploring the use of RIT, either as a single agent or as augmentation of HDC, as part of a conditioning regimen for ASCT. The flexibility of including RIT as part of conditioning therapy also allows it to be combined with RIC to reduce the toxic effects of HDC. This treatment option replaces any concomitant loss of chemotherapy efficacy with a gain in RIT efficacy. The data so far suggest that the use of RIT in the autologous setting can improve clinical outcome with no added toxicity in these patients, whereas similar positive findings have been reported in preliminary studies of yttrium-90 ibritumomab tiuxetan combined with RIC and alloSCT in high-risk patients.

Original languageEnglish (US)
Pages (from-to)41-51
Number of pages11
JournalThe oncologist
Volume14 Suppl 2
DOIs
StatePublished - Jan 1 2009

Fingerprint

Radioimmunotherapy
Stem Cell Transplantation
Non-Hodgkin's Lymphoma
Drug Therapy
Therapeutics
Behavior Therapy
Whole-Body Irradiation
Poisons
Treatment Failure
Population
Disease-Free Survival
Lymphoma
Radiation
Safety
Recurrence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Radioimmunotherapy for stem cell transplantation in non-Hodgkin's lymphoma : in pursuit of a complete response. / Gisselbrecht, Christian; Vose, Julie Marie; Nademanee, Auayporn; Gianni, Alessandro M.; Nagler, Arnon.

In: The oncologist, Vol. 14 Suppl 2, 01.01.2009, p. 41-51.

Research output: Contribution to journalReview article

Gisselbrecht, Christian ; Vose, Julie Marie ; Nademanee, Auayporn ; Gianni, Alessandro M. ; Nagler, Arnon. / Radioimmunotherapy for stem cell transplantation in non-Hodgkin's lymphoma : in pursuit of a complete response. In: The oncologist. 2009 ; Vol. 14 Suppl 2. pp. 41-51.
@article{9cfb1e7729964b1ba868299dcc2db17a,
title = "Radioimmunotherapy for stem cell transplantation in non-Hodgkin's lymphoma: in pursuit of a complete response.",
abstract = "High-dose chemotherapy (HDC) conditioning given in association with autologous stem cell transplantation (ASCT) or reduced-intensity conditioning (RIC) with allogeneic stem cell transplantation (alloSCT) are established treatment approaches for patients with chemotherapy-sensitive, relapsed, aggressive, or low-grade non-Hodgkin's lymphoma (NHL). These approaches have been shown to be the only curative option for patients with relapsed NHL. Despite data suggesting that prolonged event-free survival can be achieved with SCT combined with HDC, there are problems that may limit the utility of this approach for a broad patient population. For example, older patients, who make up the majority of the NHL population, may not be able to withstand the toxicities associated with this intensive regimen, and this therapy combination, especially when it includes the use of total-body irradiation, has been associated with a greater risk for secondary malignancies. Furthermore, relapse is the most common cause of treatment failure after HDC with ASCT and there is a poor success rate for those patients with either chemotherapy-refractory or heavily pretreated, multiple-relapsed disease. Consequently, there is an urgent need for other effective and well-tolerated approaches that will eradicate the residual disease that may persist before SCT, thus improving outcomes for patients with this life-threatening disease. In addition, approaches with better safety profiles would allow older patients to benefit from this therapeutic option. Because lymphomas are highly sensitive to radiation, radioimmunotherapy (RIT) has been used with great success in consolidation therapy and, as a result, there is great interest in exploring the use of RIT, either as a single agent or as augmentation of HDC, as part of a conditioning regimen for ASCT. The flexibility of including RIT as part of conditioning therapy also allows it to be combined with RIC to reduce the toxic effects of HDC. This treatment option replaces any concomitant loss of chemotherapy efficacy with a gain in RIT efficacy. The data so far suggest that the use of RIT in the autologous setting can improve clinical outcome with no added toxicity in these patients, whereas similar positive findings have been reported in preliminary studies of yttrium-90 ibritumomab tiuxetan combined with RIC and alloSCT in high-risk patients.",
author = "Christian Gisselbrecht and Vose, {Julie Marie} and Auayporn Nademanee and Gianni, {Alessandro M.} and Arnon Nagler",
year = "2009",
month = "1",
day = "1",
doi = "10.1634/theoncologist.2009-S2-41",
language = "English (US)",
volume = "14 Suppl 2",
pages = "41--51",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",

}

TY - JOUR

T1 - Radioimmunotherapy for stem cell transplantation in non-Hodgkin's lymphoma

T2 - in pursuit of a complete response.

AU - Gisselbrecht, Christian

AU - Vose, Julie Marie

AU - Nademanee, Auayporn

AU - Gianni, Alessandro M.

AU - Nagler, Arnon

PY - 2009/1/1

Y1 - 2009/1/1

N2 - High-dose chemotherapy (HDC) conditioning given in association with autologous stem cell transplantation (ASCT) or reduced-intensity conditioning (RIC) with allogeneic stem cell transplantation (alloSCT) are established treatment approaches for patients with chemotherapy-sensitive, relapsed, aggressive, or low-grade non-Hodgkin's lymphoma (NHL). These approaches have been shown to be the only curative option for patients with relapsed NHL. Despite data suggesting that prolonged event-free survival can be achieved with SCT combined with HDC, there are problems that may limit the utility of this approach for a broad patient population. For example, older patients, who make up the majority of the NHL population, may not be able to withstand the toxicities associated with this intensive regimen, and this therapy combination, especially when it includes the use of total-body irradiation, has been associated with a greater risk for secondary malignancies. Furthermore, relapse is the most common cause of treatment failure after HDC with ASCT and there is a poor success rate for those patients with either chemotherapy-refractory or heavily pretreated, multiple-relapsed disease. Consequently, there is an urgent need for other effective and well-tolerated approaches that will eradicate the residual disease that may persist before SCT, thus improving outcomes for patients with this life-threatening disease. In addition, approaches with better safety profiles would allow older patients to benefit from this therapeutic option. Because lymphomas are highly sensitive to radiation, radioimmunotherapy (RIT) has been used with great success in consolidation therapy and, as a result, there is great interest in exploring the use of RIT, either as a single agent or as augmentation of HDC, as part of a conditioning regimen for ASCT. The flexibility of including RIT as part of conditioning therapy also allows it to be combined with RIC to reduce the toxic effects of HDC. This treatment option replaces any concomitant loss of chemotherapy efficacy with a gain in RIT efficacy. The data so far suggest that the use of RIT in the autologous setting can improve clinical outcome with no added toxicity in these patients, whereas similar positive findings have been reported in preliminary studies of yttrium-90 ibritumomab tiuxetan combined with RIC and alloSCT in high-risk patients.

AB - High-dose chemotherapy (HDC) conditioning given in association with autologous stem cell transplantation (ASCT) or reduced-intensity conditioning (RIC) with allogeneic stem cell transplantation (alloSCT) are established treatment approaches for patients with chemotherapy-sensitive, relapsed, aggressive, or low-grade non-Hodgkin's lymphoma (NHL). These approaches have been shown to be the only curative option for patients with relapsed NHL. Despite data suggesting that prolonged event-free survival can be achieved with SCT combined with HDC, there are problems that may limit the utility of this approach for a broad patient population. For example, older patients, who make up the majority of the NHL population, may not be able to withstand the toxicities associated with this intensive regimen, and this therapy combination, especially when it includes the use of total-body irradiation, has been associated with a greater risk for secondary malignancies. Furthermore, relapse is the most common cause of treatment failure after HDC with ASCT and there is a poor success rate for those patients with either chemotherapy-refractory or heavily pretreated, multiple-relapsed disease. Consequently, there is an urgent need for other effective and well-tolerated approaches that will eradicate the residual disease that may persist before SCT, thus improving outcomes for patients with this life-threatening disease. In addition, approaches with better safety profiles would allow older patients to benefit from this therapeutic option. Because lymphomas are highly sensitive to radiation, radioimmunotherapy (RIT) has been used with great success in consolidation therapy and, as a result, there is great interest in exploring the use of RIT, either as a single agent or as augmentation of HDC, as part of a conditioning regimen for ASCT. The flexibility of including RIT as part of conditioning therapy also allows it to be combined with RIC to reduce the toxic effects of HDC. This treatment option replaces any concomitant loss of chemotherapy efficacy with a gain in RIT efficacy. The data so far suggest that the use of RIT in the autologous setting can improve clinical outcome with no added toxicity in these patients, whereas similar positive findings have been reported in preliminary studies of yttrium-90 ibritumomab tiuxetan combined with RIC and alloSCT in high-risk patients.

UR - http://www.scopus.com/inward/record.url?scp=75349111310&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=75349111310&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2009-S2-41

DO - 10.1634/theoncologist.2009-S2-41

M3 - Review article

VL - 14 Suppl 2

SP - 41

EP - 51

JO - Oncologist

JF - Oncologist

SN - 1083-7159

ER -