Outcome of lower-intensity allogeneic transplantation in non-Hodgkin lymphoma after autologous transplantation failure Journal Article
| Authors: | Freytes, C. O.; Zhang, M. J.; Carreras, J.; Burns, L. J.; Gale, R. P.; Isola, L.; Perales, M. A.; Seftel, M.; Vose, J. M.; Miller, A. M.; Gibson, J.; Gross, T. G.; Rowlings, P. A.; Inwards, D. J.; Pavlovsky, S.; Martino, R.; Marks, D. I.; Hale, G. A.; Smith, S. M.; Schouten, H. C.; Slavin, S.; Klumpp, T. R.; Lazarus, H. M.; van Besien, K.; Hari, P. N. |
| Article Title: | Outcome of lower-intensity allogeneic transplantation in non-Hodgkin lymphoma after autologous transplantation failure |
| Abstract: | 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. © 2012 American Society for Blood and Marrow Transplantation. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; disease-free survival; middle aged; survival analysis; treatment failure; transplantation, homologous; young adult; major clinical study; overall survival; fludarabine; disease course; methotrexate; follow up; progression free survival; relapse; recurrence; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; cancer mortality; risk assessment; survival time; nonhodgkin lymphoma; whole body radiation; karnofsky performance status; lymphoma, non-hodgkin; lymphoma; graft versus host reaction; reduced intensity conditioning; transplantation conditioning; allogeneic hematopoietic stem cell transplantation; cancer relapse; multivariate analysis; tacrolimus; transplantation, autologous; cyclosporin; autologous hematopoietic stem cell transplantation; autotransplantation; allogeneic; reduced-intensity; unrelated donors |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 18 |
| Issue: | 8 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-08-01 |
| Start Page: | 1255 |
| End Page: | 1264 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2011.12.581 |
| PROVIDER: | scopus |
| PMCID: | PMC3376237 |
| PUBMED: | 22198543 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 1 August 2012" - "CODEN: BBMTF" - "Source: Scopus" |
