Faculty Collaboration Database

Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation. Br J Haematol 2016 Jul;174(2):235-48

Date

03/19/2016

Pubmed ID

26989808

Pubmed Central ID

PMC4940282

DOI

10.1111/bjh.14046

Scopus ID

2-s2.0-84978080661 (requires institutional sign-in at Scopus site)   104 Citations

Abstract

For diffuse large B-cell lymphoma (DLBCL) patients progressing after autologous haematopoietic cell transplantation (autoHCT), allogeneic HCT (alloHCT) is often considered, although limited information is available to guide patient selection. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 503 patients who underwent alloHCT after disease progression/relapse following a prior autoHCT. The 3-year probabilities of non-relapse mortality, progression/relapse, progression-free survival (PFS) and overall survival (OS) were 30, 38, 31 and 37% respectively. Factors associated with inferior PFS on multivariate analysis included Karnofsky performance status (KPS) <80, chemoresistance, autoHCT to alloHCT interval <1-year and myeloablative conditioning. Factors associated with worse OS on multivariate analysis included KPS<80, chemoresistance and myeloablative conditioning. Three adverse prognostic factors were used to construct a prognostic model for PFS, including KPS<80 (4 points), autoHCT to alloHCT interval <1-year (2 points) and chemoresistant disease at alloHCT (5 points). This CIBMTR prognostic model classified patients into four groups: low-risk (0 points), intermediate-risk (2-5 points), high-risk (6-9 points) or very high-risk (11 points), predicting 3-year PFS of 40, 32, 11 and 6%, respectively, with 3-year OS probabilities of 43, 39, 19 and 11% respectively. In conclusion, the CIBMTR prognostic model identifies a subgroup of DLBCL patients experiencing long-term survival with alloHCT after a failed prior autoHCT.

Author List

Fenske TS, Ahn KW, Graff TM, DiGilio A, Bashir Q, Kamble RT, Ayala E, Bacher U, Brammer JE, Cairo M, Chen A, Chen YB, Chhabra S, D'Souza A, Farooq U, Freytes C, Ganguly S, Hertzberg M, Inwards D, Jaglowski S, Kharfan-Dabaja MA, Lazarus HM, Nathan S, Pawarode A, Perales MA, Reddy N, Seo S, Sureda A, Smith SM, Hamadani M

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin
Timothy Fenske MD Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Samantha M. Jaglowski MD, MPH Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Disease Progression
Disease-Free Survival
Drug Resistance
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Large B-Cell, Diffuse
Middle Aged
Myeloablative Agonists
Prognosis
Recurrence
Remission Induction
Risk Assessment
Survival Rate
Transplantation Conditioning
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome
Young Adult