Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation.
OBJECTIVE
Several studies have investigated the feasibility of allogeneic hematopoietic cell transplantations (HCTs) after reduced-intensity conditioning in patients who experienced relapse after myeloablative HCT. Although most studies showed relatively low nonrelapse mortality (NRM) rates and encouraging short-term results, it has yet to be defined which patients would benefit most from these approaches.


METHODS
We analyzed data from 147 patients with hematologic malignancies who experienced treatment failure with conventional autologous (n = 135), allogeneic (n = 10), or syngeneic (n = 2) HCT and were treated with HLA-matched related (n = 62) or unrelated (n = 85) grafts after conditioning with 2 Gy of total-body irradiation with or without fludarabine.


RESULTS
Three-year probabilities of NRM, relapse, and overall survival were 32%, 48%, and 27%, respectively, for related recipients, and 28%, 44%, and 44%, respectively, for unrelated recipients. The best outcomes were observed in patients with non-Hodgkin's lymphoma, whereas patients with multiple myeloma and Hodgkin's disease had worse outcomes as a result of high incidences of relapse and progression. Being in partial remission (PR) or complete remission (CR) at HCT (P = .002) and developing chronic graft-versus-host disease (GVHD; P = .03) resulted in lower risks of relapse and progression. Factors associated with better overall survival were PR or CR (P = .01) and lack of comorbidity (P = .03) at HCT and absence of acute GVHD after HCT (P = .06).


CONCLUSIONS
Encouraging outcomes were seen with allogeneic HCT after nonmyeloablative conditioning in selected patients who had experienced relapse after a high-dose HCT, particularly in patients with non-Hodgkin's lymphoma. Results with unrelated grafts were comparable with results with related grafts.
Baron
Frédéric
F
Fred Hutchinson Cancer Research Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98109-1024, USA.
Storb
Rainer
R
Storer
Barry E
BE
Maris
Michael B
MB
Niederwieser
Dietger
D
Shizuru
Judith A
JA
Chauncey
Thomas R
TR
Bruno
Benedetto
B
Forman
Stephen J
SJ
McSweeney
Peter A
PA
Maziarz
Richard T
RT
Pulsipher
Michael A
MA
Agura
Edward D
ED
Wade
James
J
Sorror
Mohamed
M
Maloney
David G
DG
Sandmaier
Brenda M
BM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000601:surgery; D006801:Humans; D019520:Living Donors; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D019653:Myeloablative Agonists