title: Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan.
abstract: We conducted a nation-wide survey of 112 adult Japanese patients who underwent reduced-intensity stem cell transplantation (RIST) from 1999 to 2002. Underlying diseases included indolent (n=45), aggressive (n=58) and highly aggressive lymphomas (n=9). Median age of the patients was 49 years. A total of 40 patients (36%) had relapsed diseases after autologous stem cell transplantation and 36 patients (32%) had received radiotherapy. RIST regimens were fludarabine-based (n=95), low-dose total body irradiation-based (n=6) and others (n=11). Cumulative incidences of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were, respectively, 49 and 59%. Cumulative incidences of progression and progression-free mortality were 18 and 25%, respectively. With a median follow-up of 23.9 months, 3-year overall survival rates were 59%. A multivariate analysis identified three significant factors for progression, which are history of radiation (relative risk (RR) 3.45, confidential interval (CI) 1.12-10.0, P=0.03), central nervous system involvement (RR 6.25, CI 2.08-20.0, P=0.001) and development of GVHD (RR 0.28, CI 0.090-0.86, P=0.026). RIST may have decreased the rate of transplant-related mortality, and GVHD may have induced a graft-versus-lymphoma effect. However, whether or not these potential benefits can be directly translated into improved patient survival should be evaluated in further studies.
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Kusumi
authors.forename: M
authors.initials: M
authors.lastname: Kami
authors.forename: Y
authors.initials: Y
authors.lastname: Kanda
authors.forename: N
authors.initials: N
authors.lastname: Murashige
authors.forename: Y
authors.initials: Y
authors.lastname: Kishi
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.forename: T E
authors.initials: TE
authors.lastname: Tanimoto
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.forename: K
authors.initials: K
authors.lastname: Muta
authors.forename: T
authors.initials: T
authors.lastname: Tamaki
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Yamane
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Takaue
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease; D020350:Graft vs Tumor Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007564:Japan; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012306:Risk; D033581:Stem Cell Transplantation; D013997:Time Factors; D016896:Treatment Outcome