title: Matched-cohort analysis of autologous hematopoietic cell transplantation with radioimmunotherapy versus total body irradiation-based conditioning for poor-risk diffuse large cell lymphoma.
abstract: We conducted a matched-cohort analysis of autologous transplant conditioning regimens for diffuse large cell lymphoma in 92 patients treated with either radioimmunotherapy (RIT) or total body irradiation (TBI)-based conditioning regimens. The RIT regimen consisted of 0.4 mCi/kg of (90)Y-ibritumomab tiuxetan plus BEAM (BCNU, etoposide, cytarabine, melphalan). The TBI-based regimen combined fractionated TBI at 1200 cGy, with etoposide and cyclophosphamide. Five factors were matched between 46 patient pairs: age at transplant ±5 years, disease status at salvage, number of prior regimens, year of diagnosis ±5 years, and year of transplantation ±5 years. Patients in the TBI group had higher rates of cardiac toxicity and mucositis, whereas Z-BEAM patients had a higher incidence of pulmonary toxicity. Overall survival at 4 years was 81.0% for the Z-BEAM and 52.7% for the TBI group (P = .01). The 4-year cumulative incidence of relapse/progression was 40.4% and 42.1% for Z-BEAM and TBI, respectively (P = .63). Nonrelapse mortality was superior in the Z-BEAM group: 0% compared with 15.8% for TBI at 4 years (P < .01). Our data demonstrate that RIT-based conditioning had a similar relapse incidence to TBI, with lower toxicity, resulting in improved overall survival, particularly in patients with ≥2 prior regimens.
authors.affiliation: Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, California 91010, USA. akrishnan@coh.org
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.forename: Joycelynne M
authors.initials: JM
authors.lastname: Palmer
authors.forename: Ni-Chun
authors.initials: NC
authors.lastname: Tsai
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Simpson
authors.forename: Auayporn
authors.initials: A
authors.lastname: Nademanee
authors.forename: Andrew
authors.initials: A
authors.lastname: Raubitschek
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Thomas
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016499:Radioimmunotherapy / Q000379:methods*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D019275:Radiopharmaceuticals; D000069283:Rituximab; C422802:ibritumomab tiuxetan