A comparison of HLA-identical sibling allogeneic versus autologous transplantation for diffuse large B cell lymphoma: a report from the CIBMTR.
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.
Lazarus
Hillard M
HM
Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA. hillard.lazarus@case.edu
Zhang
Mei-Jie
MJ
Carreras
Jeanette
J
Hayes-Lattin
Brandon M
BM
Ataergin
Asli Selmin
AS
Bitran
Jacob D
JD
Bolwell
Brian J
BJ
Freytes
César O
CO
Gale
Robert Peter
RP
Goldstein
Steven C
SC
Hale
Gregory A
GA
Inwards
David J
DJ
Klumpp
Thomas R
TR
Marks
David I
DI
Maziarz
Richard T
RT
McCarthy
Philip L
PL
Pavlovsky
Santiago
S
Rizzo
J Douglas
JD
Shea
Thomas C
TC
Schouten
Harry C
HC
Slavin
Shimon
S
Winter
Jane N
JN
van Besien
Koen
K
Vose
Julie M
JM
Hari
Parameswaran N
PN
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