Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning.
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.
Kahl
Christoph
C
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Storer
Barry E
BE
Sandmaier
Brenda M
BM
Mielcarek
Marco
M
Maris
Michael B
MB
Blume
Karl G
KG
Niederwieser
Dietger
D
Chauncey
Thomas R
TR
Forman
Stephen J
SJ
Agura
Edward
E
Leis
Jose F
JF
Bruno
Benedetto
B
Langston
Amelia
A
Pulsipher
Michael A
MA
McSweeney
Peter A
PA
Wade
James C
JC
Epner
Elliot
E
Bo Petersen
Finn
F
Bethge
Wolfgang A
WA
Maloney
David G
DG
Storb
Rainer
R
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