title: T-cell-depleted allogeneic transplant without donor leukocyte infusions results in excellent long-term survival in patients with multiply relapsed Lymphoma. Predictors for survival after transplant relapse.
abstract: We analyzed 67 patients with lymphoma who received alemtuzumab-based conditioning regimens for allogeneic stem cell transplant and no post-transplant DLI. The median age was 54 (24-70), 43% had unrelated donors, 34% had chemotherapy refractory disease, and 25% had an elevated LDH. With a median follow-up for survivors of 35 months, the estimated 3-year progression-free survival (PFS) and overall survival (OS) were 30% and 47%, respectively. Chemosensitivity by CT and pre-transplant LDH were independent prognostic factors for both overall survival and progression-free survival. Patient age, performance status, donor type, lymphoma subtype, disease sensitivity by PET, and conditioning regimen did not correlate with PFS and OS. Patients who relapsed greater than 6 months after allogeneic transplant were frequently able to re-enter a subsequent durable remission. Our experience confirms the curative potential of alemtuzumab-containing RIC regimens for allogeneic HCT in patients with relapsed lymphoma without prophylactic DLI. An elevated pre-transplant LDH and chemorefractory disease prior to transplant confer a worse prognosis, while PET scan findings do not have this same implication. Patients who relapse greater than 6 months after their transplant are likely to achieve a subsequent remission with any of a variety of interventions, suggesting that GVL effects can be operative even after recurrence. Our outcomes challenge the utility of the common practice of prophylactic DLI after T-depleted transplant for lymphoma.
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA.
authors.forename: Vaishalee P
authors.initials: VP
authors.lastname: Kenkre
authors.forename: Sarah
authors.initials: S
authors.lastname: Horowitz
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.forename: Chuanhong
authors.initials: C
authors.lastname: Liao
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Cohen
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Godley
authors.forename: Justin P
authors.initials: JP
authors.lastname: Kline
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Wendy
authors.initials: W
authors.lastname: Stock
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D020350:Graft vs Tumor Effect / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D017708:Leukocyte Transfusion; D008212:Lymphocyte Depletion; D008223:Lymphoma / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D007770:L-Lactate Dehydrogenase