title: Alternate donor hematopoietic cell transplantation (HCT) in non-Hodgkin lymphoma using lower intensity conditioning: a report from the CIBMTR.
abstract: We analyzed the outcomes of 248 (61% male) adult recipients of HLA-matched unrelated and HLA-mismatched related donor hematopoietic cell transplantation (HCT) for non-Hodgkin lymphoma (NHL) after reduced or lower intensity conditioning (RIC), reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1997 to 2004. Median age was 52 (range: 18-72 years); 31% had a Karnofsky performance score <90. Follicular NHL (43%) was the major histology. Incidence of grades II-IV acute graft-versus-host disease (aGVHD) was 43% at 100 days; and chronic GVHD (cGVHD) was 44% at 3 years. Treatment-related mortality (TRM) at 100 days was 24%. Three-year overall survival (OS) and progression-free survival (PFS) were 41% and 32%, respectively. In multivariate analysis, use of antithymocyte globulin (ATG) and HLA mismatch were associated with increased TRM. High-grade histology, ATG use, and chemotherapy resistance were associated with lower PFS. Older age, shorter interval from diagnosis to HCT, non-total body irridiation (TBI) conditioning regimens, ex vivo T cell depletion, and HLA-mismatched unrelated donors were associated with mortality. GVHD did not influence relapse or PFS. Older age, aggressive histology, and chemotherapy resistance correlated with poorer survival. For selected patients with NHL, lack of an available sibling donor should not be a barrier to allogeneic HCT.
authors.affiliation: All Children's Hospital, St. Petersburg, Florida, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Smriti
authors.initials: S
authors.lastname: Shrestha
authors.forename: Jennifer
authors.initials: J
authors.lastname: Le-Rademacher
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Jack W
authors.initials: JW
authors.lastname: Hsu
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008212:Lymphocyte Depletion; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D014916:Whole-Body Irradiation
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens