title: Outcome of lower-intensity allogeneic transplantation in non-Hodgkin lymphoma after autologous transplantation failure.
abstract: We studied the outcome of allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning regimens (reduced-intensity conditioning and nonmyeloablative) in patients with non-Hodgkin lymphoma who relapsed after autologous hematopoietic stem cell transplantation. Nonrelapse mortality, lymphoma progression/relapse, progression-free survival (PFS), and overall survival were analyzed in 263 patients with non-Hodgkin lymphoma. All 263 patients had relapsed after a previous autologous hematopoietic stem cell transplantation and then had undergone allogeneic hematopoietic stem cell transplantation from a related (n = 26) or unrelated (n = 237) donor after reduced-intensity conditioning (n = 128) or nonmyeloablative (n = 135) and were reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2006. The median follow-up of survivors was 68 months (range, 3-111 months). Three-year nonrelapse mortality was 44% (95% confidence interval [CI], 37%-50%). Lymphoma progression/relapse at 3 years was 35% (95% CI, 29%-41%). Three-year probabilities of PFS and overall survival were 21% (95% CI, 16%-27%) and 32% (95% CI, 27%-38%), respectively. Superior Karnofsky Performance Score, longer interval between transplantations, total body irradiation-based conditioning regimen, and lymphoma remission at transplantation were correlated with improved PFS. Allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning is associated with significant nonrelapse mortality but can result in long-term PFS. We describe a quantitative risk model based on pretransplantation risk factors to identify those patients likely to benefit from this approach.
authors.affiliation: South Texas Veterans Health Care System/University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: Alan M
authors.initials: AM
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gross
authors.forename: Philip A
authors.initials: PA
authors.lastname: Rowlings
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Santiago
authors.initials: S
authors.lastname: Pavlovsky
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Simon
authors.initials: S
authors.lastname: Slavin
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult