This article is more than 5 years old. Information may no longer be current.
Type of conditioning may increase infection risk for lymphoma subtype
Click Here to Manage Email Alerts
SALT LAKE CITY — Patients with central nervous system lymphoma who underwent conditioning with thiotepa, busulfan and cyclophosphamide prior to autologous hematopoietic stem cell transplantation showed increased risk for DNA virus infections compared with patients with non-Hodgkin lymphoma who received traditional conditioning, according to retrospective study results presented at the BMT Tandem Meetings.
“We’ve known for some time that consolidation is critical to successful outcomes in patients with CNS lymphoma,” Michael Scordo, MD, medical oncologist and hematologist at Memorial Sloan Kettering Cancer Center, said during his presentation. “High-dose therapy with autologous stem cell transplant has emerged as a highly effective consolidation strategy.
“We know that TBC [thiotepa, busulfan and cyclophosphamide] conditioning is effective, but it’s associated with a high toxicity burden,” Scordo added.
In a prior study, Scordo and colleagues observed “striking” incidence of some infections among patients with CNS lymphoma undergoing autologous HSCT conditioning with TBC. Specifically, they noted 81% had oral and GI mucositis, and 51% had infections. They also observed DNA viral activations.
However, whether TBC conditioning increased risk compared with traditional BEAM conditioning — which includes carmustine, etoposide, cytarabine and melphalan — was unknown. Scordo and colleagues sought to compare infections among patients after TBC- and BEAM-conditioned transplant and assess possible risk factors for these infections.
The analysis included data from 57 patients (mean age, 55 years; 33% men) with CNS lymphoma who received TBC conditioning and 79 patients (mean age, 55 years; 48% men) with systemic diffuse large B-cell lymphoma who underwent BEAM conditioning between 2013 and 2016.
Researchers used serum polymerase chain reaction to evaluate infections that occurred from the start of conditioning to 6 months, using a combined viral infection endpoint that included cytomegalovirus, adenovirus, Epstein-Barr virus, BK virus, and human herpesvirus-6.
Seven viral reactions occurred among patients who underwent BEAM conditioning, including five cases of human herpesvirus-6 and one each of cytomegalovirus and adenovirus.
Conversely, researchers observed 19 infections — 13 cases of human herpesvirus-6, five cytomegalovirus and one adenovirus — among patients who underwent TBC conditioning.
The proportion of patients who developed a virus in each arm represented a significant difference (11.5% vs. 35.1%; P = .0003).
None of the viral infection in the BEAM cohort were considered clinically relevant, compared with seven in the TBC cohort (0% vs. 16%; P = .002).
Results of a univariate analysis showed TBC was the only characteristic associated with a greater risk for viral reactivation (HR = 4.07; 95% CI, 1.71-9.69).
This association persisted in a multivariable model (HR = 4.59; 95% CI, 1.9-11.1). Researchers also observed a slightly reduced risk associated with older age (HR = 0.97; 95% CI, 0.94-99).
These differences may be explained by a few factors, Scordo said.
“There may be inherent difference in immune function in CNS lymphoma patients compared with systemic non-Hodgkin lymphoma patients,” he said. “We do know that TBC is a fairly intensive regimen, and this may be a product of the highly intense regimen.
“With the increasing use of TBC conditioning for CNS lymphoma, we believe TBC patients may be a population to consider early DNA virus polymerase chain reaction monitoring and pre-emptive therapy to prevent serious viral organ disease,” he added. – by Alexandra Todak
Disclosures: The authors report no relevant financial disclosures.