Reduced-intensity compared to nonmyeloablative conditioning in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic stem cell transplantation Journal Article
| Authors: | Nath, K.; Peterson, K.; Brown, S.; Devlin, S.; Rodriguez, N.; Barker, J.; Giralt, S.; Gyurkocza, B.; Jakubowski, A.; Papadopoulos, E.; Ponce, D.; Scordo, M.; Shah, G.; Perales, M. A.; Sauter, C.; Lin, A.; Dahi, P. B. |
| Article Title: | Reduced-intensity compared to nonmyeloablative conditioning in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic stem cell transplantation |
| Abstract: | Reduced-intensity conditioning (RIC) and nonmyeloablative (NMA) conditioning are preferred for patients with non-Hodgkin lymphoma (NHL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT). Although prior studies have suggested that higher-intensity regimens in RIC-NMA conditioning are associated with inferior outcomes in patients with NHL, the optimal conditioning regimen remains unknown. We performed a retrospective single-center analysis to determine outcomes of adult patients with B cell and T cell NHL who underwent allo-HCT and received either RIC or NMA conditioning between March 2008 and December 2019. RIC regimens included fludarabine-cyclophosphamide-thiotepa-4 Gy-total body irradiation (Flu-Cy-TT-4Gy-TBI), fludarabine-melphalan (Flu-Mel), fludarabine-cyclophosphamide-4 Gy-total body irradiation (Flu-Cy-4Gy-TBI), and fludarabine-busulfan-4 (Flu-Bu-4). The NMA regimen comprised fludarabine-cyclophosphamide-2 Gy-total body irradiation (Flu-Cy-2Gy-TBI). The primary outcome was overall survival (OS); secondary outcomes included progression-free survival (PFS), nonrelapse mortality (NRM), and the incidence of acute and chronic graft-versus-host-disease (GVHD). Of 279 transplants recipients (median age, 58 years), 110 received RIC (55% Flu-Mel, 38% Flu-Cy-TT-4Gy-TBI, 6% Flu-Bu-4, 1% Flu-Cy-4Gy-TBI) and 169 received NMA conditioning with Flu-Cy-2Gy-TBI. With a median of 64 months of follow-up post-allo-HCT, there was no significant difference in OS between the NMA and RIC groups (median, not reached [NR] versus 103 months; P =.1), and this was maintained on multivariable analysis. Similarly, after adjustment for all independently significant covariates (age, Karnofsky Performance Status [KPS], Hematopoietic Cell Transplantation Comorbidity Index [HCT-CI], and disease histology), the regression analysis showed no significant difference in PFS with RIC compared to NMA conditioning (hazard ratio [HR] 1.38; 95% confidence interval [CI],.92 to 2.09; P =.24). On univariable analysis, there was no significant difference in NRM between the RIC and NMA arms (100-day estimate, 10.0% versus 1.8%; P =.5). After adjustment for age, ethnicity, KPS, HCT-CI, GVHD prophylaxis, and donor source, RIC conditioning was associated with a significantly higher incidence of NRM compared to NMA conditioning (HR, 2.61; 95% CI, 1.04 to 6.52; P =.039). On multivariable analysis, compared with the NMA arm, the RIC arm had higher rates of grade II-IV (HR, 2.25; 95% CI, 1.31 to 3.86; P =.002) and grade III-IV acute GVHD (HR, 5.62; 95% CI, 2.03 to 15.6; P <.001). The findings of this study suggest that NMA conditioning with Flu-Cy-TBI-2Gy may be considered over more intensive RIC regimens for patients with NHL undergoing allo-HCT. © 2023 The American Society for Transplantation and Cellular Therapy |
| Keywords: | adult; middle aged; survival analysis; retrospective studies; transplantation, homologous; busulfan; cyclophosphamide; hematopoietic stem cell transplantation; retrospective study; thiotepa; lymphoma, non-hodgkin; graft versus host reaction; graft vs host disease; allotransplantation; non-hodgkin lymphoma; allogeneic transplantation; complication; conditioning regimen; humans; human |
| Journal Title: | Transplantation and Cellular Therapy |
| Volume: | 30 |
| Issue: | 1 |
| ISSN: | 2666-6367 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-01-01 |
| Start Page: | 81 |
| End Page: | 92 |
| Language: | English |
| DOI: | 10.1016/j.jtct.2023.09.022 |
| PUBMED: | 37788792 |
| PROVIDER: | scopus |
| PMCID: | PMC10842498 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Parastoo Dahi -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work