 Leukemia & Lymphoma, 2014; Early Online: 1–6 © 2014 Informa UK, Ltd. ISSN: 1042-8194 print / 1029-2403 online DOI: 10.3109/10428194.2014.889827 Correspondence: Yujin Kobayashi, MD, PhD, Department of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan. Tel: + 81-3-3972-8111, ext. 2402. Fax: + 81-3-3972-2893. E-mail: eumagene@gmail.com Received 24 October 2013; revised 18 January 2014; accepted 25 January 2014 ORIGINAL ARTICLE: CLINICAL Safety and efficacy of high-dose cyclophosphamide, etoposide and ranimustine regimen followed by autologous peripheral blood stem cell transplant for patients with diffuse large B-cell lymphoma Yujin Kobayashi 1 , Yoshihiro Hatta 1 , Masahiko Sugitani 2 , Atsuko Hojo 1 , Masaru Nakagawa 1 , Machiko Kusuda 1 , Yoshihito Uchino 1 , Hiromichi Takahashi 1 , Satomi Kiso 1 , Yukio Hirabayashi 1 , Mai Yagi 1 , Hitomi Kodaira 1 , Daisuke Kurita 1 , Katsuhiro Miura 1 , Noriyoshi Iriyama 1 , Sumiko Kobayashi 1 , Yoshimasa Kura 3 , Akira Horikoshi 1 , Umihiko Sawada 3 , Jin Takeuchi 1 & Masami Takei 1 1 Department of Hematology and Rheumatology and 2 Department of Pathology, Nihon University School of Medicine, Tokyo, Japan and 3 Department of Hematology and Oncology, Kasukabe Municipal Hospital, Saitama, Japan Introduction Relapsed or refractory difuse large B-cell lymphoma (DLBCL) can be a candidate for high-dose chemotherapy (HDT) followed by autologous peripheral blood stem cell transplant (PBSCT) in patients with chemotherapy-sensitive disease [1,2]. he eicacy of upfront PBSCT for high-risk DLBCL has also been reported in terms of progression-free survival (PFS) [3]. Although several regimens containing the nitrosourea carmustine (BCNU), such as carmustine, etoposide, cytarabine and melphalan (BEAM) and cyclo- phosphamide, carmustine and etoposide (CBV), have been widely used for HDT in lymphoma, an optimal condi- tioning regimen in terms of toxicity and eicacy has not been determined [4]. We designed a new conditioning regimen using high- dose cyclophosphamide, etoposide and ranimustine (MCNU; CEM regimen) for autologous PBSCT. We report the safety and eicacy of the CEM regimen for relapsed or high-risk DLBCL or DLBCL associated with follicular lymphoma (FL/DLBCL). Patients and methods Patients Patients who underwent autologous PBSCT following the CEM regimen between March 1999 and June 2011 at Nihon University Itabashi Hospital for the treatment of relapsed or high-risk, histologically proven de novo DLBCL or FL/DLBCL were identiied from our trans- plant database. heir demographic and transplant data records were collected by chart review. High-risk DLBCL was deined as partial response (PR) or no response to initial treatment, or high-intermediate/high risk disease according to the international prognostic index (IPI) at initial diagnosis [5]. Age-adjusted IPI was used for patients under 60 years. Clinical staging was performed by com- puted tomography scanning of the neck, thorax, abdomen and pelvis, bone marrow (BM) biopsy, gallium scanning or positron emission tomography, cerebrospinal luid examination and other tools such as magnetic resonance imaging if indicated. Abstract We retrospectively evaluated the safety and eicacy of high- dose chemotherapy consisting of cyclophosphamide, etoposide and ranimustine (CEM) with autologous peripheral blood stem cell transplant (PBSCT) in 55 adult patients with relapsed or high-risk de novo difuse large B-cell lymphoma (DLBCL) or DLBCL associated with follicular lymphoma. This included 36 patients in the upfront setting in their irst complete remission. The median follow-up of 42 patients surviving at the time of the analysis was 52 months (range 1–159). Relapse or disease progression after PBSCT was a frequent cause of death, but no therapy-related mortality associated with PBSCT was observed. The 5-year overall survival and progression-free survival were 70.6% (95% conidence interval [CI], 54.0–82.1) and 57.0% (95% CI, 39.5–71.2), respectively. Chronic renal impairment, therapy- related myelodysplastic syndrome and prostate cancer were the major late complications. The CEM regimen is a tolerable, efective conditioning regimen for autologous PBSCT for DLBCL, with no therapy-related mortality observed. Keywords: Difuse large B-cell lymphoma, follicular lymphoma, autologous peripheral blood stem cell transplant, CEM regimen, high-dose chemotherapy, conditioning Leuk Lymphoma Downloaded from informahealthcare.com by Nihon Univ Igakubu on 03/23/14 For personal use only.