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Complete response induced by fotemustine given as single agent in a patient with primary central nervous system non-Hodgkin aggressive lymphoma relapsed after high-dose chemotherapy and autologous stem cell support.

Pennese E, Vergine C, Matera R, Dargenio M, Forese P, Di Renzo N - Leuk. Lymphoma (2011)

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Despite recent therapeutic advances, primary central nervous system lymphoma (PCNSL) shows the worst prognosis among all non-Hodgkin lymphomas (NHLs), with a 5-year survival rate ranging from 4 to 40%... Front-line therapy for patients with PCNSL is a combined chemo-radiotherapy regimen... This therapeutic approach has improved the complete response rate and median survival, but the prognosis of PCNSL remains poor with a high rate of fatal relapse... The patient achieved a second complete response after eight courses of FTM, as documented by MR [Figure 1(b)]... FTM was well tolerated, with the main hematological toxicity consisting of grade II thrombocytopenia... To our knowledge this represents the first report of CR achieved with fotemustine as a single agent in a patient with PCNSL relapsing after high-dose therapy and stem cell support... It is noteworthy that complete response in this patient has been achieved despite previous exposure to fotemustine, suggesting that the drug does not induce resistance... PCNSLs are rare, aggressive malignancies with a poor outcome, but potentially curable tumors... The poor prognosis of patients with PCNSL is mainly due to the low incidence of the disease, which does not permit a consistent number of patients to be enrolled in randomized clinical trials... The prognosis of relapsed-refractory patients with PCNSL is poor with the available drugs, and new agents are awaited in this field... An alkylating agent such as fotemustine could be an interesting candidate, since this drug is able to cross the blood-brain barrier... FTM is a third-generation chloroethylnitrosourea containing a phosphoalanine carrier group attached to the nitrosourea radical... The phosphoalanine group makes the drug highly lipophilic, as shown by the octanol/water partition coeffcient, which is in the optimal range compared with other nitrosoureas such as BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea] and CCNU [1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea].

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Magnetic resonance showed (a) cerebellar relapse after consolidation therapy and (b) complete response after fotemustine salvage therapy.
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fig1: Magnetic resonance showed (a) cerebellar relapse after consolidation therapy and (b) complete response after fotemustine salvage therapy.

Mentions: After a follow-up of 21 months, progressive hearing loss and ataxia appeared; CT scan and MR [Figure 1(a)] showed a cerebellar relapse. FTM was administered every 15 days at the dose of 100 mg/m2 as salvage therapy. The patient achieved a second complete response after eight courses of FTM, as documented by MR [Figure 1(b)].


Complete response induced by fotemustine given as single agent in a patient with primary central nervous system non-Hodgkin aggressive lymphoma relapsed after high-dose chemotherapy and autologous stem cell support.

Pennese E, Vergine C, Matera R, Dargenio M, Forese P, Di Renzo N - Leuk. Lymphoma (2011)

Magnetic resonance showed (a) cerebellar relapse after consolidation therapy and (b) complete response after fotemustine salvage therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3211192&req=5

fig1: Magnetic resonance showed (a) cerebellar relapse after consolidation therapy and (b) complete response after fotemustine salvage therapy.
Mentions: After a follow-up of 21 months, progressive hearing loss and ataxia appeared; CT scan and MR [Figure 1(a)] showed a cerebellar relapse. FTM was administered every 15 days at the dose of 100 mg/m2 as salvage therapy. The patient achieved a second complete response after eight courses of FTM, as documented by MR [Figure 1(b)].

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Despite recent therapeutic advances, primary central nervous system lymphoma (PCNSL) shows the worst prognosis among all non-Hodgkin lymphomas (NHLs), with a 5-year survival rate ranging from 4 to 40%... Front-line therapy for patients with PCNSL is a combined chemo-radiotherapy regimen... This therapeutic approach has improved the complete response rate and median survival, but the prognosis of PCNSL remains poor with a high rate of fatal relapse... The patient achieved a second complete response after eight courses of FTM, as documented by MR [Figure 1(b)]... FTM was well tolerated, with the main hematological toxicity consisting of grade II thrombocytopenia... To our knowledge this represents the first report of CR achieved with fotemustine as a single agent in a patient with PCNSL relapsing after high-dose therapy and stem cell support... It is noteworthy that complete response in this patient has been achieved despite previous exposure to fotemustine, suggesting that the drug does not induce resistance... PCNSLs are rare, aggressive malignancies with a poor outcome, but potentially curable tumors... The poor prognosis of patients with PCNSL is mainly due to the low incidence of the disease, which does not permit a consistent number of patients to be enrolled in randomized clinical trials... The prognosis of relapsed-refractory patients with PCNSL is poor with the available drugs, and new agents are awaited in this field... An alkylating agent such as fotemustine could be an interesting candidate, since this drug is able to cross the blood-brain barrier... FTM is a third-generation chloroethylnitrosourea containing a phosphoalanine carrier group attached to the nitrosourea radical... The phosphoalanine group makes the drug highly lipophilic, as shown by the octanol/water partition coeffcient, which is in the optimal range compared with other nitrosoureas such as BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea] and CCNU [1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea].

Show MeSH
Related in: MedlinePlus