melphalan and Thymus-Neoplasms

Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy with or without radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC), with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. The 60 study patients received either rituximab-BEAM (n = 37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) with or without vorinostat (n = 23), followed by ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range, .3 to 21 years), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group were 58% and 77%, respectively, for the entire cohort, 51% and 65% for the R-BEAM recipients, and 69% and 82% for R-vorinostat/GemBuMel recipients. Multivariable analyses showed that a negative positron emission tomography scan at ASCT (hazard ratio [HR], .28) and involvement of only 1 organ (HR, .33) were independently associated with improved PFS. In addition, receipt of R-vorinostat/GemBuMel (HR, .23) was an independent favorable predictor of OS. Our data indicate that HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Large B-Cell, Diffuse; Melphalan; Neoplasm Recurrence, Local; Retrospective Studies; Rituximab; Thymus Neoplasms; Transplantation, Autologous; Vorinostat

The heterogeneity of tumour antigen expression, the differential sensitivity of individual cells to drugs and the use drug--antibody immunoconjugates with limited potency can limit the antitumour effects of immunoconjugate therapy. In this study we have used two different antibodies linked to two different drugs Melphalan (Mel) and Idarubicin (Ida), each with a different site action, to evaluate the potential of using cocktails of immunoconjugates. A series of drug combinations were screened for their synergistic activity in vitro using the inhibition of [3H]-thyrmidine uptake by E3 cells, and constructing isobolagrams: Mel plus Ida was the only combination found to be synergistic in vitro and this synergism extended to the drugs after conjugation to antibodies. In addition, in vivo studies in mice bearing E3 tumours showed that synergy between both free drugs and between Ida-anti-Ly-2.1 and N-AcMEL-anti-Ly-3.1 immunoconjugates was time dependent, requiring treatment with Ida or Ida-MoAb conjugates prior to the addition of the second melphalan containing immunoconjugate. The use of two different antibodies, anti-Ly-2.1 and anti-Ly-3.1 against E3 (Ly-2.1+ve, Ly-3.1+ve) gave greater synergy in vitro compared to using only one antibody. Again a cocktail of two antibody immunoconjugates provided significantly greater antitumour efficacy when given to tumour bearing mice, provided that the Ida-anti-Ly-2.1 was given 24 h before injection of N-AcMEL-anti-Ly-3.1. The enhanced antitumour effect was not observed when the immunoconjugates were given simultaneously, or if the same antibody was used in each conjugate. Of importance was the finding that although the anti-tumour effect was synergistic, there was no increase in toxicity noted. The increased therapeutic index observed by using a double cocktail (2 antibodies + 2 drugs) could have major implications for immunoconjugate therapy.

Topics: Animals; Antibodies, Monoclonal; Antineoplastic Agents; Cell Survival; Drug Synergism; Idarubicin; Immunotoxins; Leukocyte Count; Melphalan; Mice; Mice, Inbred Strains; Neoplasm Transplantation; Thymoma; Thymus Neoplasms; Tumor Cells, Cultured

Twenty-six patients (median age 33 years) with poor-risk malignancies were treated with high-dose combination chemotherapy associating BCNU-etoposide-cytosine arabinoside and melphalan (BEAM) followed by autologous bone marrow transplantation (ABMT). Twenty-one patients had malignant lymphomas, three, acute lymphoblastic leukemia (ALL), and two, malignant thymomas. Eleven patients (group 1) were not in complete remission (CR) at the time of BEAM, and fifteen patients (group 2) were in CR. Hematological recovery occurred in all patients. The duration of aplasia and the non-hematological toxicities were similar in both groups. Ten of the eleven patients (group 1) evaluable for response achieved CR and one achieved partial remission (PR). Five patients relapsed, and five are in continuous CR with a short follow-up (median 8 months). Among the fifteen patients in CR at the time of BEAM (group 2), four patients relapsed and ten patients are in unmaintained continuous CR with a median follow-up of 15 months (one patient died in CR). The disease-free survival is 53%, with 29% for patients receiving BEAM while in relapse (group 1) and 65% for patients receiving BEAM while in CR (group 2). These data indicate that BEAM followed by ABMT can produce a high antitumor response with an acceptable toxicity in patients with poor-risk malignancies.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Carmustine; Child; Child, Preschool; Combined Modality Therapy; Cytarabine; Etoposide; Female; Hematologic Diseases; Humans; Leukemia, Lymphoid; Lymphoma; Male; Melphalan; Middle Aged; Recurrence; Remission Induction; Thymoma; Thymus Neoplasms

BALB/c mice cured of a large MOPC-315 or MOPC-104E plasmacytoma following treatment with a low dose (2.5 mg/kg) of melphalan (L-PAM) were resistant to challenge with the other plasmacytoma but to a much lesser extent than to challenge with the autochthonous plasmacytoma. The resistance of the L-PAM-cured MOPC-315-tumor bearers to challenge with MOPC-104E tumor cells was increased when the MOPC-104E tumor cells were admixed with MOPC-315 tumor cells prior to their inoculation. This enhanced resistance to MOPC-104E cells was due to elimination of the MOPC-104E tumor cells through an innocent bystander killing effect since it did not render the mice more resistant to a subsequent challenge with MOPC-104E tumor cells alone. Administration of carrageenan to L-PAM-cured MOPC-315-tumor bearers 1 day after the challenge with the mixture of MOPC-104E and MOPC-315 tumor cells drastically reduced the ability of the mice to resist the tumor challenge. All of the tumors that developed in such mice were of MOPC-104E origin only (as judged by the binding specificity of the myeloma proteins secreted by the tumor cells as well as that present on their surface) even though (a) the tumor inoculum used consisted of up to 10-fold more MOPC-315 than MOPC-104E tumor cells and (b) the MOPC-315 tumor cells divide more rapidly. The same protocol of carrageenan treatment did not reduce the ability of normal BALB/c mice to develop in vivo a primary cell-mediated cytotoxic response nor a primary antibody response indicating that it has no effect on the initiation of an immune response. Therefore, it is conceivable that carrageenan treatment reduced the ability of L-PAM-cured MOPC-315-tumor bearers to reject a challenge with MOPC-315 and MOPC-104E tumor cells by interfering at the effector stage. The ability of the L-PAM-cured MOPC-315-tumor bearers to reject the MOPC-315 cells present in the challenge mixture was reduced when the mice were treated with anti-Thy 1.2 antibody but not with carrageenan, indicating that T-cells independent from carrageenan-sensitive effector cells are required for the rejection of the MOPC-315 tumor cells. Thus, at least two different effector mechanisms participate in the rejection of a challenge composed of MOPC-315 and MOPC-104E tumor cells by L-PAM-cured MOPC-315-tumor bearers.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Animals; Carrageenan; Depression, Chemical; Female; Graft Rejection; Immunity, Cellular; Immunity, Innate; Melphalan; Mice; Mice, Inbred BALB C; Neoplasm Transplantation; Plasmacytoma; Thymoma; Thymus Neoplasms

To increase the accessibility of drug-antibody complexes to tumours and to decrease non-specific binding via Fc receptors N-acetyl-melphalan (N-AcMEL) was conjugated to F(ab')2 fragments. These fragments were synthesised by pepsin degradation of IgG MoAb. Up to 20 molecules of N-AcMEL could be successfully coupled to each F(ab')2 fragment (compared with 25 molecules/intact IgG) with retention of both drug and antibody activity. The N-AcMEL-F(ab')2 conjugates demonstrated specific cytotoxicity in vitro however despite the absence of non specific Fc receptor binding and greater permeability when using F(ab')2 fragments, the N-AcMEL-F(ab')2 and N-AcMEL-IgG conjugates had similar anti-tumour activity in vivo. Conjugates made with whole IgG and F(ab')2 were equally effective in eradicating subcutaneous solid tumours in mice when injected intravenously. The lower immunogenicity of F(ab')2 fragments compared with whole IgG and the similar cytotoxicity of their conjugates, suggests that the F(ab')2 conjugate has greater clinical utility.

Topics: Animals; Antibodies, Monoclonal; Antigens, Ly; Antineoplastic Agents; Immunoglobulin Fab Fragments; Lymphoma; Melphalan; Mice; Mice, Inbred Strains; Neoplasms, Experimental; Thymoma; Thymus Neoplasms

Topics: Animals; Antineoplastic Agents; Carcinoma 256, Walker; Carcinoma, Ehrlich Tumor; Female; Leukemia, Experimental; Leukocyte Count; Lymphoid Tissue; Male; Mammary Neoplasms, Experimental; Melphalan; Mice; Mice, Inbred C3H; Neoplasm Transplantation; Neoplasms, Experimental; Organ Size; Ovarian Neoplasms; Rats; Sarcoma 180; Sarcoma 37; Sarcoma, Experimental; Spleen; Splenic Neoplasms; Thymus Gland; Thymus Neoplasms; Time Factors; Triazines