Faculty Collaboration Database

Allogeneic transplants in follicular lymphoma: higher risk of disease progression after reduced-intensity compared to myeloablative conditioning. Biol Blood Marrow Transplant 2008 Feb;14(2):236-45

Date

01/25/2008

Pubmed ID

18215784

Pubmed Central ID

PMC2531158

DOI

10.1016/j.bbmt.2007.11.004

Scopus ID

2-s2.0-38149063716 (requires institutional sign-in at Scopus site)   142 Citations

Abstract

Reduced-intensity conditioning (RIC) regimens have been increasingly used for allogeneic hematopoietic stem cell transplantation (HSCT) in follicular lymphoma (FL). We compared traditional myeloablative conditioning regimens to RIC in FL. Outcomes of HLA-identical sibling HSCT for FL in 208 recipients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 1997 and 2002 were studied. Conditioning regimens were categorized as myeloablative (N = 120) or RIC (N = 88). Use of RIC regimens increased from <10% of transplants in 1997 to >80% in 2002 signaling a major shift in practice. Patients receiving RIC were older and had a longer interval from diagnosis to transplant. These differences did not correlate with outcomes. Median follow-up of survivors was 50 months (4-96 months) after myeloablative conditioning versus 35 months (4-82 months) after RIC (P < .001). At 3 years, overall survival (OS) for the myeloablative and RIC cohorts were 71 (63%-79%) and 62 (51%-72%; P = .15) and progression free survival (PFS), 67 (58%-75%) and 55 (44%-65%; P = .07), respectively. Lower Karnofsky performance score (KPS) and resistance to chemotherapy were associated with higher treatment-related mortality (TRM) and lower OS and PFS. On multivariate analysis, an increased risk of lymphoma progression after RIC was observed (relative risk = 2.97, P = .04). RIC has become the de facto standard in allogeneic HSCT for FL, and appears to result in similar long-term outcomes. Although disease-free survival (DPS) is similar compared to myeloablative conditioning, an increased risk of late disease progression after RIC is concerning.

Author List

Hari P, Carreras J, Zhang MJ, Gale RP, Bolwell BJ, Bredeson CN, Burns LJ, Cairo MS, Freytes CO, Goldstein SC, Hale GA, Inwards DJ, Lemaistre CF, Maharaj D, Marks DI, Schouten HC, Slavin S, Vose JM, Lazarus HM, van Besien K

Authors

Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
Mei-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

Antineoplastic Agents
Data Collection
Disease Progression
Hematopoietic Stem Cell Transplantation
Histocompatibility Testing
Humans
Karnofsky Performance Status
Lymphoma, Follicular
Risk
Siblings
Survival Analysis
Transplantation Conditioning
Transplantation, Homologous
Whole-Body Irradiation