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Yttrium-90 ibritumomab tiuxetan (Zevalin) followed by BEAM (Z-BEAM) conditioning regimen and autologous stem cell transplantation (ASCT) in relapsed or refractory high-risk B-cell non-Hodgkin lymphoma (NHL): a single institution Italian experience

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Abstract

Chemo-refractory NHL has a very poor outcome; the addiction of RIT to salvage regiment pre ASCT had recently demonstrated promising results.We performed a retrospective sequential study to determine the feasibility of standard Zevalin with BEAM in high-risk relapse/refractory NHL. A matched cohort analysis with a group treated with standard BEAM without Zevalin was performed as secondary endpoint. Between October 2006 and January 2013, 37 NHL patients at high risk for progression or early (< 1 year) or multiple relapses were treated with Z-BEAM and ASCT after R-DHAP or R-ICE as salvage therapy. Clinical characteristics were 19 refractory and 18 early or multiple relapse; 16 patients received 1, and 21 had 2 or more previous rituximab-containing chemotherapy. At the end of treatment, response was CR 22 (59%), PR 10 (27%), PD 4 (11%), and toxic death (TD) 1 (3%). With a median follow up of 61 months, 3-year PFS was 61% and OS 61%. Fifteen patients died, 12 of lymphoma. Comparison with 21 treated with BEAM alone showed a numerical higher 3-yr PFS rate in favor of Z-BEAM but not statistically significant (57 vs 48%). With the limitation of the small sample subgroup analysis, a significant benefit was observed in relapsed patients for PFS (78% Z-BEAM vs 22% BEAM p = 0.016) and OS (83% Z-BEAM vs 22% BEAM p = 0.001). In relapsed/refractory high-risk NHL, Z-BEAM+ASCT is able to achieve a good ORR. Three-year PFS is promising for early relapsed patients but is not satisfactory for those with refractory disease.

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Authors and Affiliations

  1. Hematology Department, Città della Salute e della Scienza, Corso Bramante 88, 10126, Turin, Italy

    Chiara Ciochetto, Barbara Botto, Roberto Passera, Marilena Bellò, Giulia Benevolo, Carola Boccomini, Alessia Castellino, Annalisa Chiappella, Roberto Freilone, Maura Nicolosi, Lorella Orsucci, Clara Pecoraro, Patrizia Pregno, Gianni Bisi & Umberto Vitolo

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  1. Chiara Ciochetto
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  2. Barbara Botto
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  3. Roberto Passera
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  4. Marilena Bellò
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Contributions

Chiara Ciochetto, Barbara Botto, and Umberto Vitolo designed the study; Chiara Ciochetto, Barbara Botto, and Umberto Vitolo supervised the study, analyzed the data, and wrote the manuscript. Roberto Passera analyzed and interpreted the data, and all authors enrolled patients and reviewed and approved the final manuscript.

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Correspondence to Chiara Ciochetto.

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Conflict of interest

Umberto Vitolo was on the advisory committee of Roche, Janssen and received a lecture fee from Roche, Celgene, Janssen, Takeda, and Gilead.

The remaining authors declare no competing financial interests.

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Ciochetto, C., Botto, B., Passera, R. et al. Yttrium-90 ibritumomab tiuxetan (Zevalin) followed by BEAM (Z-BEAM) conditioning regimen and autologous stem cell transplantation (ASCT) in relapsed or refractory high-risk B-cell non-Hodgkin lymphoma (NHL): a single institution Italian experience. Ann Hematol 97, 1619–1626 (2018). https://doi.org/10.1007/s00277-018-3328-3

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