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High-dose chemotherapy (melphalan in myeloma, BEAM in lymphoma) that would permanently destroy the bone marrow, made survivable by giving the patient back their own previously collected stem cells, which engraft in 10-14 days. Standard for fit myeloma patients and relapsed Hodgkin lymphoma; the cells rescue the marrow, they do not fight the cancer.
Stem cells are mobilised with G-CSF (plus plerixafor), collected by apheresis and frozen; after melphalan (myeloma) or BEAM (lymphoma) conditioning they are reinfused and engraft in 10-14 days. ASCT after quadruplet induction remains standard for fit myeloma patients (PERSEUS, DETERMINATION) though CAR-T is challenging it (CARTITUDE-5/6); in DLBCL it has been displaced from second line by CAR-T (ZUMA-7, TRANSFORM) but remains for later relapse and for Hodgkin lymphoma and germ cell tumours; tandem transplant is part of high-risk neuroblastoma therapy. Mortality is 1-2%; risks are infection during aplasia and later secondary MDS.
Showing the molecule this term concerns: Melphalan (including hepatic delivery system).
The reason second-line CAR-T is offered with axicabtagene ciloleucel or lisocabtagene maraleucel rather than tisagenlecleucel. The trial is also the strongest evidence in the field that the interval between apheresis and infusion, and what is given during it, is part of the treatment rather than logistics around it.
One of the few maintenance strategies in lymphoma that improved overall survival rather than only progression-free survival, and the reason three years of rituximab became standard after autologous transplantation in mantle cell lymphoma.
The regimen that made extranodal NK/T-cell lymphoma treatable. The usual explanation is that asparaginase is not a substrate of the P-glycoprotein pump this tumour expresses, which would explain why it works where anthracycline-based regimens do not; that mechanism is widely repeated but has been contradicted by at least one series.
Shares Transplant or CAR-T at second line in diffuse large B-cell lymphoma, TRANSFORM, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7.
Shares Transplant or CAR-T at second line in diffuse large B-cell lymphoma, TRANSFORM, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7.
Shares Apheresis (leukapheresis), Salvage therapy, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7.
Shares TRANSFORM, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting.
Shares TRANSFORM, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting.
Shares LyMa, Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma, Stem cell transplant in lymphoma: what it is still for, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting.
Shares TRANSFORM, Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma, ZUMA-7, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting.
Shares VRd and Dara-VRd (myeloma induction regimens), Plasma cell leukaemia, Newly diagnosed multiple myeloma, transplant-eligible, Multiple myeloma.