title: Histology and time to progression predict survival for lymphoma recurring after reduced-intensity conditioning and allogeneic hematopoietic cell transplantation.
abstract: Reduced-intensity conditioning (RIC) before allogeneic hematopoietic cell transplantation (HCT) is increasingly used as a potentially curative option for patients with advanced lymphoma; however, relapse remains a major challenge. Unfortunately, little data are available on outcomes, predictors of survival, and results of specific management strategies in these patients. In the present study, a total of 101 consecutive relapses occurred and were evaluated in 280 patients with lymphoma who underwent RIC HCT. Diseases included aggressive non-Hodgkin lymphoma (NHL) (n = 42), indolent NHL (n = 33), and Hodgkin lymphoma (HL) (n = 26). Median time to relapse was 90 days (range, 3-1275 days), and graft-versus-host disease at relapse was present in 56 patients (55%). Interventions after relapse included no therapy (n = 14), withdrawal of immunosuppression alone (n = 11), chemoradiotherapy (n = 60), and donor lymphocyte infusion/second HCT (n = 16). Overall survival (OS) was 33% (95% confidence interval [CI], 23%-44%) at 3 years after relapse and 23% (95% CI, 13%-34%) at 5 years after relapse. Both aggressive NHL (vs indolent disease; hazard ratio, 2.29; P = .008) and relapse within 1 month post-HCT (vs >6 months; hazard ratio, 3.17; P = .004) were associated with increased mortality. Estimated 3-year OS was 16% (95% CI, 5%-32%) after relapse for aggressive NHL, 40% (95% CI, 19%-61%) after relapse for indolent NHL, and 47% (95% CI, 29%-64%) after relapse for HL. The 1-year survival was 24% for patients relapsing within 1 month post-HCT, compared with 52% for those relapsing at 1-3 months, 74% for those relapsing at 3-6 months, and 77% for those relapsing at more than 6 months. We conclude that despite relapse of lymphoma after RIC HCT, some patients may experience prolonged survival, with better postrelapse outcomes occurring in patients with indolent NHL, HL, or late relapse.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.forename: Ted A
authors.initials: TA
authors.lastname: Gooley
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Press
authors.forename: John M
authors.initials: JM
authors.lastname: Pagel
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Petersdorf
authors.forename: Andrei R
authors.initials: AR
authors.lastname: Shustov
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: Paul
authors.initials: P
authors.lastname: O'Donnell
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Rainer F
authors.initials: RF
authors.lastname: Storb
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Gopal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006651:Histocytochemistry / Q000379:methods; D006689:Hodgkin Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous