Sequential intensive chemotherapy followed by autologous or allogeneic transplantation for refractory lymphoma

We evaluate the safety of bendamustine as a bridge to stem cell transplantation (SCT) in patients with relapsed/refractory lymphoma and residual disease after salvage therapy. Thirty-four subjects without complete responses (CR) received bendamustine 200 mg/m(2)/day for 2 days followed 14 days later by SCT. Sixteen subjects in partial remission (PR) with maximal FDG-PET SUVs <= 8 prior to bendamustine received autologous SCT, while 13 with suboptimal responses were allografted. Five subjects did not proceed to transplant. No bendamustine toxicities precluded transplantation and no detrimental effect on engraftment or early treatment-related mortality (TRM) was attributable to bendamustine. At 1 year, 75% of auto-recipients and 31% of allo-recipients were alive with CR. Two subjects in the autologous arm developed therapy-related myeloid neoplasia (t-MN). In conclusion, a bendamustine bridge to SCT can be administered without early toxicity to patients with suboptimal responses to salvage chemotherapy. However this approach may increase the risk of t-MN. (NCT02059239). Supplemental data for this article is available online at .

Automated summary

The study evaluated the safety and efficacy of using bendamustine as a bridge to stem cell transplantation in patients with relapsed/refractory lymphoma, with findings indicating potential benefits for some patients while also raising the risk of therapy-related myeloid neoplasia. Bendamustine did not cause toxicities precluding transplantation, but there were cases of therapy-related myeloid neoplasia observed in some patients, suggesting a need for careful consideration of risks and benefits in clinical decision-making.