title: Autologous or allogeneic stem cell transplantation in patients with Waldenstrom's macroglobulinemia.
abstract: The role of hematopoietic stem cell transplantation (SCT) in Waldenstrom's macroglobulinemia (WM) has not been extensively studied. To determine the potential for long-term disease control using SCT in WM, we performed a retrospective review of 36 patients with WM who received autologous (n = 10) or allogeneic (n = 26) SCT and were reported to the Center for International Blood and Marrow Transplant Research between 1986 and 2002. The following outcomes were described: nonrelapse mortality (NRM), relapse, progression-free survival (PFS), and overall survival (OS). Median age at the time of SCT was 51 years (range, 30-76 years), and median time from initial treatment to SCT was 29 months (range, 2-198 months). A total of 78% of the patients had 2 or more previous chemotherapy regimens, and 52% had disease resistant to salvage chemotherapy. In the allogeneic SCT group, 58% of the patients received myeloablative conditioning regimens containing total body irradiation (TBI), and of the allograft recipients, 19% received nonmyeloablative/reduced-intensity conditioning. After a median follow-up of 65 months, 15 of the 36 patients (42%) are alive. Primary disease accounted for 29% of the deaths in the allogeneic SCT group and 25% of the deaths in the autologous SCT group. The relapse rate at 3 years was 29% (95% confidence interval [CI], 14%-48%) in the allogeneic group and 24% (95% CI, 4%-54%) in the autologous group. PFS at 3 years was 31% (95% CI, 14%-50%) in the allogeneic group and 65% (95% CI, 32%-91%) in the autologous group; OS was 46% (95% CI, 27%-65%) in the allogeneic group and 70% (95% CI, 40%-93%) in the autologous group. NRM at 3 years was 40% (95% CI, 23%-59%) in the allogeneic group and 11% (95% CI, 0-36%) in the autologous group. Autologous SCT is a safe and feasible treatment option for patients with WM, especially for those who present with adverse prognostic factors. Allogeneic SCT carries a much higher (40%) risk of NRM and should not be considered outside the context of a clinical trial.
authors.affiliation: Medical Oncology, Alexandra Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Anagnostopoulos
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Donna E
authors.initials: DE
authors.lastname: Reece
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000401:mortality; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods / Q000401:mortality; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D008258:Waldenstrom Macroglobulinemia / Q000401:mortality* / Q000628:therapy