Myeloablative allogeneic hematopoietic stem cell transplantation in patients who experience relapse after autologous stem cell transplantation for lymphoma: a report of the International Bone Marrow Transplant Registry.
Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.
Freytes
César O
CO
University of Texas Health Science Center, Mail Code 7880, 7703 Floyd Curl Dr, San Antonio, TX 78229-3900, USA. freytes@uthscsa.edu.
Loberiza
Fausto R
FR
Rizzo
J Douglas
JD
Bashey
Asad
A
Bredeson
Christopher N
CN
Cairo
Mitchell S
MS
Gale
Robert Peter
RP
Horowitz
Mary M
MM
Klumpp
Thomas R
TR
Martino
Rodrigo
R
McCarthy
Philip L
PL
Molina
Arturo
A
Pavlovsky
Santiago
S
Pecora
Andrew L
AL
Serna
Derek S
DS
Tsai
Tsuong
T
Zhang
Mei-Jie
MJ
Vose
Julie M
JM
Lazarus
Hillard M
HM
van Besien
Koen
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D019653:Myeloablative Agonists