melphalan and Lymphoma--Large-Cell--Anaplastic

No standard treatment for relapsed or refractory anaplastic large-cell lymphoma (ALCL) has been established. This study is a multicenter, open-label trial to examine the effectiveness and safety of transplantation with reduced-intensity conditioning (RIC) for patients under 20 years old with relapsed or refractory ALCL. We defined RIC as the administration of fludarabine (30 mg/m2/day) for five days plus melphalan (70 mg/m2/day) for two days and total body irradiation at 4 Gy, followed by allogeneic hematopoietic stem cell transplantation.

Topics: Adolescent; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Child; Clinical Trials as Topic; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Large-Cell, Anaplastic; Melphalan; Transplantation Conditioning; Vidarabine

We report a retrospective analysis of 38 patients (age ≤ 30 years) who underwent allogeneic hematopoietic stem cell transplantation (allo-SCT) for relapsed or refractory anaplastic large-cell lymphoma (ALCL). Median follow-up for survivors after undergoing allo-SCT was 72 months (range, 35-96 months). Eight patients received reduced-intensity conditioning (RIC) regimens, including three patients with fludarabine plus melphalan-based regimens and five patients with fludarabine plus busulfan-based regimens. The remaining 30 patients received myeloablative conditioning (MAC) regimens. Median ages in the RIC and MAC groups were 24 and 15 years, respectively. The 5-year overall survival rates in the RIC and MAC groups were 100% and 49%, respectively (P = 0.018). The 5-year event-free survival rates in the RIC and MAC groups were 88% and 43%, respectively (P = 0.039). In the RIC group, four of the eight patients showed residual disease at allo-SCT, but all eight patients survived with complete remission (CR), including one patient with relapse. This result suggests that allo-SCT using the RIC regimen may be effective for relapsed or refractory ALCL in children, adolescents, and young adults, even in non-CR cases.

Topics: Adolescent; Adult; Antineoplastic Agents, Alkylating; Busulfan; Child; Female; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Large-Cell, Anaplastic; Male; Melphalan; Remission Induction; Retrospective Studies; Salvage Therapy; Survival Analysis; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome; Vidarabine; Young Adult

Primary cutaneous CD30-positive T-cell lymphoproliferative disorders (CD30(+) LPD), including primary cutaneous anaplastic large cell lymphoma (CALCL) and lymphomatoid papulosis (LyP), comprise the second most common group of cutaneous T-cell lymphomas (CTCL). The etiology of these disorders is not known. Isolated limb perfusion (ILP) and isolated limb infusion (ILI) are forms of regional chemotherapy used to treat recurrent tumors of the extremity, most commonly, melanoma. Secondary malignancy following regional therapy is rarely reported.. We identified two cases of CD30(+) LPD arising in the affected limbs of patients treated with ILP/ILI. We subsequently performed CD30 immunohistochemical stains on 11 pre- and post-treatment skin specimens from melanoma patients treated with ILP/ILI and found that 5 of the 11 cases showed an increase in CD30(+) lymphocytes following ILP/ILI.. We hypothesize that ILP/ILI causes upregulation of CD30 expression in the extremities of treated patients, and suggest that this may be a marker of treatment response. However, a rare but long-term effect may be an increased risk of T-cell cutaneous lymphoproliferative disease in the affected limb.

Topics: Antineoplastic Agents, Alkylating; Chemotherapy, Cancer, Regional Perfusion; Female; Humans; Immunohistochemistry; Ki-1 Antigen; Lymphocytes; Lymphoma, Large-Cell, Anaplastic; Lymphomatoid Papulosis; Male; Melanoma; Melphalan; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Skin Neoplasms

Topics: Adult; Anaplastic Lymphoma Kinase; Antineoplastic Combined Chemotherapy Protocols; Brentuximab Vedotin; Carmustine; Cisplatin; Combined Modality Therapy; Compassionate Use Trials; Crizotinib; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Etoposide; Humans; Immunoconjugates; Lymphocyte Transfusion; Lymphoma, Large-Cell, Anaplastic; Male; Melphalan; Molecular Targeted Therapy; Neoplasm Proteins; Peripheral Blood Stem Cell Transplantation; Prednisone; Protein Kinase Inhibitors; Pyrazoles; Pyridines; Receptor Protein-Tyrosine Kinases; Remission Induction; Respiration, Artificial; Respiratory Insufficiency; Transplantation, Homologous; Vincristine

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Brentuximab Vedotin; Carmustine; Clinical Trials, Phase I as Topic; Cyclophosphamide; Cytarabine; Doxorubicin; Etoposide; Humans; Immunoconjugates; Lymphoma, Large-Cell, Anaplastic; Maintenance Chemotherapy; Male; Melphalan; Prednisone; Remission Induction; Stem Cell Transplantation; Transplantation, Autologous; Vincristine

Topics: Antigens, CD34; Antineoplastic Combined Chemotherapy Protocols; Blood Preservation; Carmustine; Cell Count; Child, Preschool; Combined Modality Therapy; Cryopreservation; Cyclophosphamide; Cytarabine; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Mobilization; Hematopoietic Stem Cell Transplantation; Humans; Immunomagnetic Separation; Leukapheresis; Lymphoma, Large-Cell, Anaplastic; Melphalan; Podophyllotoxin; Recurrence; Transplantation, Autologous