title: A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma.
abstract: 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.
authors.affiliation: University of Michigan Medical Center, Ann Arbor, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Levine
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: Koen
authors.initials: K
authors.lastname: Van Besien
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Steve C
authors.initials: SC
authors.lastname: Goldstein
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Laughlin
authors.forename: John
authors.initials: J
authors.lastname: Lister
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Alan M
authors.initials: AM
authors.lastname: Miller
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Milone
authors.forename: Santiago
authors.initials: S
authors.lastname: Pavlovsky
authors.forename: Amdrew L
authors.initials: AL
authors.lastname: Pecora
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Gary
authors.initials: G
authors.lastname: Schiller
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Mei Jie
authors.initials: MJ
authors.lastname: Zhang
mesh_terms: 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