title: Low nonrelapse mortality and prolonged long-term survival after reduced-intensity allogeneic stem cell transplantation for relapsed or refractory diffuse large B cell lymphoma: report of the Société Française de Greffe de Moelle et de Thérapie Cellulaire.
abstract: Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) have a very poor prognosis. However, they may achieve long-term survival by undergoing allogeneic stem cell transplantation (SCT). The purpose of this study was to assess the outcome of all adult patients with DLBCL whose treatment included a reduced-intensity conditioning (RIC) regimen for allogeneic SCT and whose data were reported in the French Society of Marrow Transplantation and Cellular Therapy registry. Sixty-eight patients (median age: 48 years) were transplanted from October 1998 to January 2007. They had received a median of 2 regimens of therapy prior to allogeneic SCT, and 54 (79%) had already undergone SCT. Prior to transplantation, 32 patients (47%) were in complete remission (CR). For all patients but 1, conditioning regimens were based on fludarabine (Flu), which was combined with other chemotherapy drugs in 50 cases (74%) and with total body irradiation (TBI) in 17 (25%). For 56 patients (82%), the donor was an HLA-matched sibling, and peripheral blood was the most widely used source of stem cells (57 patients, 84%). With a median follow-up of 49 months, estimated 2-year overall survival (OS), progression-free survival (PFS), and the cumulative incidence of relapse were 49%, 44%, and 41%, respectively. The 1-year cumulative incidence of nonrelapse mortality (NRM) was 23%. According to multivariate analysis, the patients in CR before transplantation had a significantly longer PFS and a lower CI of relapse than patients transplanted during partial remission or stable or progressive disease. These results suggest that reduced-intensity allergenic transplantation is an attractive therapeutic option for patients with high-risk DLBCL.
authors.affiliation: Hospital Archet, Nice, France. sirvent.a@chu-nice.fr
authors.forename: Anne
authors.initials: A
authors.lastname: Sirvent
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhedin
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.forename: Laurence
authors.initials: L
authors.lastname: Clement
authors.forename: Karin
authors.initials: K
authors.lastname: Bilger
authors.forename: Fabrice
authors.initials: F
authors.lastname: Larosa
authors.forename: Nathalie
authors.initials: N
authors.lastname: Contentin
authors.forename: Anne
authors.initials: A
authors.lastname: Huyn
authors.forename: Sylvie
authors.initials: S
authors.lastname: François
authors.forename: Claude-Eric
authors.initials: CE
authors.lastname: Bulabois
authors.forename: Patrice
authors.initials: P
authors.lastname: Ceballos
authors.forename: Jean-Henri
authors.initials: JH
authors.lastname: Bourrhis
authors.forename: Agnès
authors.initials: A
authors.lastname: Buzyn
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Gaelle
authors.initials: G
authors.lastname: Guillerm
authors.forename: Thierry
authors.initials: T
authors.lastname: de Revel
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.forename: François
authors.initials: F
authors.lastname: Guilhot
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000145:classification / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D013223:Statistics as Topic; D033581:Stem Cell Transplantation / Q000401:mortality*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult