Outcome of lower-intensity allogeneic transplantation in non-Hodgkin lymphoma after autologous transplantation failure. Biol Blood Marrow Transplant 2012 Aug;18(8):1255-64
Date
12/27/2011Pubmed ID
22198543Pubmed Central ID
PMC3376237DOI
10.1016/j.bbmt.2011.12.581Scopus ID
2-s2.0-84864017956 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
We studied the outcome of allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning regimens (reduced-intensity conditioning and nonmyeloablative) in patients with non-Hodgkin lymphoma who relapsed after autologous hematopoietic stem cell transplantation. Nonrelapse mortality, lymphoma progression/relapse, progression-free survival (PFS), and overall survival were analyzed in 263 patients with non-Hodgkin lymphoma. All 263 patients had relapsed after a previous autologous hematopoietic stem cell transplantation and then had undergone allogeneic hematopoietic stem cell transplantation from a related (n = 26) or unrelated (n = 237) donor after reduced-intensity conditioning (n = 128) or nonmyeloablative (n = 135) and were reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2006. The median follow-up of survivors was 68 months (range, 3-111 months). Three-year nonrelapse mortality was 44% (95% confidence interval [CI], 37%-50%). Lymphoma progression/relapse at 3 years was 35% (95% CI, 29%-41%). Three-year probabilities of PFS and overall survival were 21% (95% CI, 16%-27%) and 32% (95% CI, 27%-38%), respectively. Superior Karnofsky Performance Score, longer interval between transplantations, total body irradiation-based conditioning regimen, and lymphoma remission at transplantation were correlated with improved PFS. Allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning is associated with significant nonrelapse mortality but can result in long-term PFS. We describe a quantitative risk model based on pretransplantation risk factors to identify those patients likely to benefit from this approach.
Author List
Freytes CO, Zhang MJ, Carreras J, Burns LJ, Gale RP, Isola L, Perales MA, Seftel M, Vose JM, Miller AM, Gibson J, Gross TG, Rowlings PA, Inwards DJ, Pavlovsky S, Martino R, Marks DI, Hale GA, Smith SM, Schouten HC, Slavin S, Klumpp TR, Lazarus HM, van Besien K, Hari PNAuthors
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of WisconsinMei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Non-Hodgkin
Male
Middle Aged
Multivariate Analysis
Recurrence
Survival Analysis
Transplantation Conditioning
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome
Young Adult