title: A comparison of HLA-identical sibling allogeneic versus autologous transplantation for diffuse large B cell lymphoma: a report from the CIBMTR.
abstract: We compared outcomes of 916 diffuse large B cell lymphoma (DLBCL) patients aged >or=18 years undergoing first autologous (n = 837) or myeloablative (MA) allogeneic hematopoietic cell transplant (HCT) (n = 79) between 1995 and 2003 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Median follow-up was 81 months for allogeneic HCT versus 60 months for autologous HCT. Allogeneic HCT recipients were more likely to have high-risk disease features including higher stage, more prior chemotherapy regimens, and resistant disease. Allogeneic HCT was associated with a higher 1 year treatment-related mortality (TRM) (relative risk [RR] 4.88, 95% confidence interval [CI], 3.21-7.40, P < .001), treatment failure (RR 2.06, 95% CI, 1.54-2.75, P < .001), and mortality (RR 2.75, 95% CI, 2.03-3.72, P < .001). Risk of disease progression was similar in the 2 groups (RR 1.12, 95% CI, 0.73-1.72, P = .59). In fact, for 1-year survivors, no significant differences were observed for TRM, progression, progression-free (PFS) or overall survival (OS). Increased risks of TRM and mortality were associated with older age (>50 years), lower performance score, chemoresistance, and earlier year of transplant. In a cohort of mainly high-risk DLBCL patients, upfront MA allogeneic HCT, although associated with increased early mortality, was associated with a similar risk of disease progression compared to lower risk patients receiving autologous HCT.
authors.affiliation: Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA. hillard.lazarus@case.edu
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Hayes-Lattin
authors.forename: Asli Selmin
authors.initials: AS
authors.lastname: Ataergin
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Bitran
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Steven C
authors.initials: SC
authors.lastname: Goldstein
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Santiago
authors.initials: S
authors.lastname: Pavlovsky
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Jane N
authors.initials: JN
authors.lastname: Winter
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D035781:Siblings; D013223:Statistics as Topic; D014019:Tissue Donors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult