title: Allogeneic haematopoietic stem-cell transplantation for relapsed and refractory aggressive histology non-Hodgkin lymphoma.
abstract: Forty-four patients with relapsed or refractory aggressive histology non-Hodgkin lymphoma (NHL) (diffuse large B cell, n = 23; peripheral T cell, n = 5; transformed B cell, n = 16) proceeded to allogeneic stem cell transplant (allo-SCT) between 1987 and 2003. Median age at transplant was 40 years (range 19-56 years). At the time of transplant, 35 were chemosensitive and nine were chemorefractory. Thirty-three patients had matched sibling donors and 11 had unrelated donors. Forty-two patients (95%) received radiation-based conditioning regimens. Event-free survival (EFS) and overall survival (OS) at 5 years was 43% [95% confidence interval (CI): 27-58%] and 48% (95% CI: 32-63%) respectively. Treatment-related mortality was 25% at 1 year. Grade III-IV acute graft-versus-host disease (GVHD) was the only significant variable affecting OS and EFS, and had a negative impact. Chronic GVHD did not influence survival. Lymphoma relapse <12 months after initial therapy predicted for increased risk of relapse post-transplant (P = 0.02). Patients with chemorefractory lymphoma were not at increased risk of relapse (P = 0.20) with four of nine patients remaining alive without disease 12-103 months post-transplant. In conclusion, allo-SCT for relapsed or refractory aggressive histology NHL results in long-term EFS and OS of 40-50%. Patients with chemorefractory disease can have a durable remission post-transplant.
authors.affiliation: Division of Hematology, Leukemia/Bone Marrow Transplant Program of British Columbia, The Vancouver Hospital and Health Science Centre, Vancouver, BC, Canada.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Doocey
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Toze
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: Donna L
authors.initials: DL
authors.lastname: Forrest
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hogge
authors.forename: Julye C
authors.initials: JC
authors.lastname: Lavoie
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Nantel
authors.forename: John D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Voss
authors.forename: Clayton A
authors.initials: CA
authors.lastname: Smith
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous