Allogeneic Transplantation for Relapsed Waldenström Macroglobulinemia and Lymphoplasmacytic Lymphoma. Biol Blood Marrow Transplant 2017 Jan;23(1):60-66
Date
10/30/2016Pubmed ID
27789362Pubmed Central ID
PMC5182098DOI
10.1016/j.bbmt.2016.10.010Scopus ID
2-s2.0-85006371447 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) is characterized by lymphoplasmacytic proliferation, lymph node and spleen enlargement, bone marrow involvement, and IgM production. Treatment varies based on the extent and biology of disease. In some patients, the use of allogeneic hematopoietic cell transplantation (alloHCT) may have curative potential. We evaluated long-term outcomes of 144 patients who received adult alloHCT for WM/LPL. Data were obtained from the Center for International Blood and Marrow Transplant Research database (2001 to 2013). Patients received myeloablative(n = 67) or reduced-intensity conditioning (RIC; n = 67). Median age at alloHCT was 53 years, and median time from diagnosis to transplantation was 41 months. Thirteen percent (n = 18) failed prior autologous HCT. About half (n = 82, 57%) had chemosensitive disease at the time of transplantation, whereas 22% had progressive disease. Rates of progression-free survival, overall survival, relapse, and nonrelapse mortality at 5 years were 46%, 52%, 24%, and 30%, respectively. Patients with chemosensitive disease and better pretransplant disease status experienced significantly superior overall survival. There were no significant differences in progression-free survival based on conditioning (myeloablative, 50%, versus RIC, 41%) or graft source. Conditioning intensity did not impact treatment-related mortality or relapse. The most common causes of death were primary disease and graft-versus-host disease (GVHD). AlloHCT yielded durable survival in select patients with WM/LPL. Strategies to reduce mortality from GVHD and post-transplant relapse are necessary to improve this approach.
Author List
Cornell RF, Bachanova V, D'Souza A, Woo-Ahn K, Martens M, Huang J, Al-Homsi AS, Chhabra S, Copelan E, Diaz MA, Freytes CO, Gale RP, Ganguly S, Hamadani M, Hildebrandt G, Kamble RT, Kharfan-Dabaja M, Kindwall-Keller T, Lazarus HM, Marks DI, Nishihori T, Olsson RF, Saad A, Usmani S, Vesole DH, Yared J, Mark T, Nieto Y, Hari PAuthors
Anita D'Souza MD Associate Professor in the Medicine department at Medical College of WisconsinMehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
Michael Martens PhD Assistant 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
Databases, Factual
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma
Middle Aged
Recurrence
Survival Analysis
Time-to-Treatment
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome
Waldenstrom Macroglobulinemia
Young Adult