Long-term outcomes after reduced-intensity conditioning allogeneic stem cell transplantation for low-grade lymphoma: a survey by the French Society of Bone Marrow Graft Transplantation and Cellular Therapy (SFGM-TC).
OBJECTIVE
High-dose chemotherapy with allogeneic stem cell transplantation (SCT) has proven to be a successful treatment for low-grade lymphoma (LGL), but is associated with considerable transplant-related mortality (TRM). In an effort to reduce toxic mortality while maintaining the graft-versus-leukemia effect, allogeneic SCT has been combined with a reduced-intensity conditioning (RIC) regimen. The aim of this study was to determine the outcome of patients with LGL treated with RIC allogeneic SCT.


METHODS
This retrospective multicenter study included 73 patients with relapsed or refractory LGL allografted after a RIC regimen between 1998 and 2005 whose data were recorded in a French registry.


RESULTS
Patients received a median of three lines of therapy prior to RIC allogeneic SCT. The most widely used conditioning regimens were fludarabine + busulfan + antithymocyte globulin (n=43) and fludarabine + total body irradiation (n=21). Prior to allografting, patients were in complete response (CR; n=21), partial response (PR; n=33) or had chemoresistant disease (n=19). The median follow-up was 37 months (range, 16 to 77 months). In patients in CR, PR and chemoresistant disease, the 3-year overall survival rates were 66%, 64% and 32%, respectively, while the 3-year event-free survival rates were 66%, 52% and 32%, respectively. The 3-year cumulative incidences of TRM were 32%, 28% and 63%, respectively. The incidence of relapse was 9.6%.


CONCLUSIONS
Although associated with significant TRM, RIC allogeneic SCT in advanced chemosensitive disease leads to long-term survival.
Vigouroux
Stéphane
S
Service d'Hématologie Clinique, Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France. vigouroux.st@wanadoo.fr
Michallet
Mauricette
M
Porcher
Raphaël
R
Attal
Michel
M
Ades
Lionel
L
Bernard
Marc
M
Blaise
Didier
D
Tabrizi
Reza
R
Garban
Frédéric
F
Cassuto
Jill-Patrice
JP
Chevalier
Patrice
P
Facon
Thierry
T
Ifrah
Norbert
N
Renaud
Marc
M
Tilly
Hervé
H
Vernant
Jean-Paul
JP
Kuentz
Mathieu
M
Bourhis
Jean-Henri
JH
Bordigoni
Pierre
P
Deconinck
Eric
E
Lioure
Bruno
B
Socié
Gérard
G
Milpied
Noël
N
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002066:Busulfan / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003625:Data Collection; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D015996:Survival Rate; D013601:T-Lymphocytes; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D008558:Melphalan; D002330:Carmustine