title: Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning.
abstract: Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for hematologic malignancies depends on graft-versus-tumor effects for eradication of cancer. Here, we estimated relapse risks according to disease characteristics. Between 1997 and 2006, 834 consecutive patients (median age, 55 years; range, 5-74 years) received related (n = 498) or unrelated (n = 336) HCT after 2 Gy total body irradiation alone (n = 171) or combined with fludarabine (90 mg/m(2); n = 663). Relapse rates per patient year (PY) at risk, corrected for follow-up and competing nonrelapse mortality, were calculated for 29 different diseases and stages. The overall relapse rate per PY was 0.36. Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in remission (CR), low-grade or mantle cell non-Hodgkin lymphoma (NHL) (CR + partial remission [PR]), and high-grade NHL-CR had the lowest rates (0.00-0.24; low risk). In contrast, patients with advanced myeloid and lymphoid malignancies had rates of more than 0.52 (high risk). Patients with lymphoproliferative diseases not in CR (except Hodgkin lymphoma and high-grade NHL) and myeloid malignancies in CR had rates of 0.26-0.37 (standard risk). In conclusion, patients with low-grade lymphoproliferative disorders experienced the lowest relapse rates, whereas patients with advanced myeloid and lymphoid malignancies had high relapse rates after nonmyeloablative HCT. The latter might benefit from cytoreductive treatment before HCT.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kahl
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Marco
authors.initials: M
authors.lastname: Mielcarek
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.forename: Karl G
authors.initials: KG
authors.lastname: Blume
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Chauncey
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
authors.forename: Edward
authors.initials: E
authors.lastname: Agura
authors.forename: Jose F
authors.initials: JF
authors.lastname: Leis
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Amelia
authors.initials: A
authors.lastname: Langston
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: Peter A
authors.initials: PA
authors.lastname: McSweeney
authors.forename: James C
authors.initials: JC
authors.lastname: Wade
authors.forename: Elliot
authors.initials: E
authors.lastname: Epner
authors.forename: Finn
authors.initials: F
authors.lastname: Bo Petersen
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Bethge
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002469:Cell Separation; D002648:Child; D002675:Child, Preschool; D005260:Female; D042381:Granulocyte Precursor Cells / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000145:classification / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012306:Risk; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous