A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma.
Lymphoblastic lymphoma (LBL) is a rare, clinically aggressive neoplasm of the young that frequently involves the bone marrow (BM) and/or central nervous system. Because LBL is similar to acute lymphoblastic leukemia, some centers prefer allogeneic hematopoietic stem cell (SC) transplantation to autologous SC transplantation. We retrospectively analyzed outcomes for patients who underwent autologous (auto, n = 128) or HLA-identical sibling (allo, n = 76) SC transplantations from 1989 to 1998 and were reported to International Bone Marrow Transplant Registry (IBMTR) or Autologous Blood and Marrow Transplant Registry (ABMTR). Allo stem cell transplant (SCT) recipients had higher treatment-related mortality (TRM) at 6 months (18% versus 3%, P =.002), and this disadvantage persisted at 1 and 5 years. Early relapse rates after alloSC transplantation and autoSC transplantation were similar, but significantly lower relapse rates were observed in alloSCT recipients at 1 and 5 years (32% versus 46%, P =.05; and 34% versus 56%, P =.004, respectively). No differences were noted in lymphoma-free survival rates between alloSC transplantations and autoSC transplantations (5-year rates 36% versus 39%, P =.82). AutoSCT recipients had higher overall survival at 6 months (75% versus 59%, P =.01), but survival did not significantly differ between the 2 groups at 1 and 5 years (60% versus 49%, P =.09; 44% versus 39%, P =.47, respectively). Multivariate analyses to account for confounding factors confirmed these results. Independent of SCT type, BM involvement at the time of transplantation and disease status more advanced than first complete remission were associated with inferior outcomes. In summary, alloSC transplantation for LBL is associated with fewer relapses than with autoSC transplantation, but higher TRM offsets any potential survival benefit.
Levine
John E
JE
University of Michigan Medical Center, Ann Arbor, USA.
Harris
Richard E
RE
Loberiza
Fausto R
FR
Armitage
James O
JO
Vose
Julie M
JM
Van Besien
Koen
K
Lazarus
Hillard M
HM
Horowitz
Mary M
MM
Bashey
Asad
A
Bolwell
Brian J
BJ
Burns
Linda J
LJ
Cairo
Mitchell S
MS
Champlin
Richard E
RE
Freytes
Cesar O
CO
Gibson
John
J
Goldstein
Steve C
SC
Laughlin
Mary J
MJ
Lister
John
J
Marks
David I
DI
Maziarz
Richard T
RT
Miller
Alan M
AM
Milone
Gustavo A
GA
Pavlovsky
Santiago
S
Pecora
Amdrew L
AL
Rizzo
J Douglas
JD
Schiller
Gary
G
Schouten
Harry C
HC
Zhang
Mei Jie
MJ
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000401:mortality / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000401:mortality / Q000706:statistics & numerical data; D014185:Transplantation, Isogeneic; D016896:Treatment Outcome