title: Allogeneic stem-cell transplantation as salvage therapy for patients with diffuse large B-cell non-Hodgkin's lymphoma relapsing after an autologous stem-cell transplantation: an analysis of the European Group for Blood and Marrow Transplantation Registry.
abstract: OBJECTIVE
  To analyze the outcome, including nonrelapse mortality (NRM), relapse rate (RR), progression-free survival (PFS), and overall survival (OS), of patients with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) relapsed after an autologous stem-cell transplantation (ASCT) and treated with an allogeneic stem-cell transplantation (allo-SCT).
  
  
  METHODS
  The European Group for Blood and Marrow Transplantation database was scanned for a first allo-SCT in relapsed DLBCL after a previous ASCT between 1997 and 2006. Other inclusion criteria were age at allo-SCT ≥ 18 years and availability of an HLA-identical sibling or a matched unrelated donor. A total of 101 patients (57 males; median age, 46 years) were included. Median follow-up for survivors was 36 months.
  
  
  RESULTS
  Myeloablative conditioning regimen was used in 37 patients and reduced intensity conditioning (RIC) was used in 64 patients. Three-year NRM was 28.2% (95% CI, 20% to 39%), RR was 30.1% (95% CI, 22% to 41%), PFS was 41.7% (95% CI, 32% to 52%), and OS was 53.8% (95% CI, 44% to 64%). NRM was significantly increased in patients ≥ 45 years (P = .01) and in those with an early relapse (< 12 months) after ASCT (P = .01). RR was significantly higher in refractory patients (P = .03). A time interval to relapse after ASCT of < 12 months was associated with lower PFS (P = .03). The use of RIC regimens was followed by a trend to a lower NRM (P = .1) and a trend to a higher RR (P = .1), with no differences in PFS and OS. No differences were seen between HLA-identical siblings and matched unrelated donors.
  
  
  CONCLUSIONS
  Allo-SCT in relapsed DLBCL after ASCT is a promising therapeutic modality. Patients with a long remission after ASCT and with sensitive disease at allo-SCT are the best candidates for this approach.
authors.affiliation: Hôpital Pitié Salpetrière, Paris, France.
authors.forename: Roel J W
authors.initials: RJ
authors.lastname: van Kampen
authors.forename: Carmen
authors.initials: C
authors.lastname: Canals
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Kirsty J
authors.initials: KJ
authors.lastname: Thomson
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Vernant
authors.forename: Agnes
authors.initials: A
authors.lastname: Buzyn
authors.forename: Marc A
authors.initials: MA
authors.lastname: Boogaerts
authors.forename: Jian-Jian
authors.initials: JJ
authors.lastname: Luan
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maury
authors.forename: Noel J
authors.initials: NJ
authors.lastname: Milpied
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jouet
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Ossenkoppele
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists