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
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MSK Authors
  1. Sergio Andres Giralt
    953 Giralt
  2. Doris Ponce
    232 Ponce
  3. Miguel-Angel Perales
    802 Perales
  4. Juliet N Barker
    332 Barker
  5. Sean McCarthy Devlin
    547 Devlin
  6. Parastoo Bahrami Dahi
    247 Dahi
  7. Michael Scordo
    262 Scordo
  8. Boglarka   Gyurkocza
    119 Gyurkocza
  9. Gunjan Lalitchandra Shah
    317 Shah
  10. Andrew Pei-En Lin
    44 Lin
  11. Samantha Brown
    42 Brown
  12. Karthik Nath
    22 Nath