title: Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity?
abstract: The best conditioning regimen before allogeneic transplantation for high-risk diffuse large B-cell lymphoma (DLBCL) remains to be clarified. We analyzed data from 396 recipients of allotransplants for DLBCL receiving myeloablative (MAC; n = 165), reduced intensity (RIC; n = 143), or nonmyeloablative conditioning (NMAC; n = 88) regimens. Acute and chronic GVHD rates were similar across the groups. Five-year nonrelapse mortality (NRM) was higher in MAC than RIC and NMAC (56% vs 47% vs 36%; P = .007). Five-year relapse/progression was lower in MAC than in RIC/NMAC (26% vs 38% vs 40%; P = .031). Five-year progression-free survival (15%-25%) and overall survival (18%-26%) did not differ significantly between the cohorts. In multivariate analysis, NMAC and more recent transplant year were associated with lower NRM, whereas a lower Karnofsky performance score (< 90), prior relapse resistant to therapy, and use of unrelated donors were associated with higher NRM. NMAC transplants, no prior use of rituximab, and prior relapse resistant to therapy were associated with a greater risk of relapse/progression. In conclusion, allotransplantation with RIC or NMAC induces long-term progression-free survival in selected DLBCL patients with a lower risk of NRM but with higher risk of lymphoma progression or relapse.
authors.affiliation: Department for Stem Cell Transplantation, University of Hamburg, 20246 Hamburg, Germany. u.bacher@uke.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.forename: Evgeny
authors.initials: E
authors.lastname: Klyuchnikov
authors.forename: Jennifer
authors.initials: J
authors.lastname: Le-Rademacher
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bishop
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Luis M
authors.initials: LM
authors.lastname: Isola
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Peter H
authors.initials: PH
authors.lastname: Wiernik
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006648:Histocompatibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists