title: Impact of pretransplantation conditioning regimens on outcomes of allogeneic transplantation for chemotherapy-unresponsive diffuse large B cell lymphoma and grade III follicular lymphoma.
abstract: Patients with chemorefractory non-Hodgkin lymphomas generally have a poor prognosis. We used the observational database of the Center for International Blood and Marrow Transplant Research to study the outcome of 533 patients with refractory diffuse large B cell lymphoma (DLBCL) or grade III follicular lymphoma (FL-III) who underwent allogeneic hematopoietic cell transplantation (allo-HCT) using either myeloablative (MA; n = 307) or reduced-intensity/nonmyeloablative conditioning (RIC/NST; n = 226) between 1998 and 2010. We analyzed nonrelapse mortality (NRM), relapse/progression, progression-free survival (PFS), and overall survival (OS). Only 45% of the patients at transplantation had a Karnofsky performance score of ≥90%. Median follow-up of surviving patients after MA and RIC/NST allo-HCT is 35 months and 30 months, respectively. At 3 years, MA allo-HCT was associated with a higher NRM compared with RIC/NST (53% versus 42%; P = .03), similar PFS (19% versus 23%; P = .40), and lower OS (19% versus 28%; P = .02), respectively. On multivariate analysis, FL-III histology was associated with lower NRM (relative risk [RR], .52), reduced risk of relapse/progression (RR, .42), and superior PFS (RR, .51) and OS (RR, .53), whereas MA conditioning was associated with reduced risk of relapse/progression (RR, .66). Despite a refractory state, a small subset of DLBCL and FL-III patients can attain durable remissions after allo-HCT. Conditioning regimen intensity was not associated with PFS and OS despite a higher risk of relapse/progression with RIC/NST allo-HCT.
authors: Myeloma and Lymphoma Service, West Virginia University Hospitals, Morgantown, West Virginia, USA.
authors: Mehdi
authors: M
authors: Hamadani
authors: Wael
authors: W
authors: Saber
authors: Kwang Woo
authors: KW
authors: Ahn
authors: Jeanette
authors: J
authors: Carreras
authors: Mitchell S
authors: MS
authors: Cairo
authors: Timothy S
authors: TS
authors: Fenske
authors: Robert Peter
authors: RP
authors: Gale
authors: John
authors: J
authors: Gibson
authors: Gregory A
authors: GA
authors: Hale
authors: Parameswaran N
authors: PN
authors: Hari
authors: Jack W
authors: JW
authors: Hsu
authors: David J
authors: DJ
authors: Inwards
authors: Rammurti T
authors: RT
authors: Kamble
authors: Anderas
authors: A
authors: Klein
authors: Dipnarine
authors: D
authors: Maharaj
authors: David I
authors: DI
authors: Marks
authors: David A
authors: DA
authors: Rizzieri
authors: Bipin N
authors: BN
authors: Savani
authors: Harry C
authors: HC
authors: Schouten
authors: Edmund K
authors: EK
authors: Waller
authors: Baldeep
authors: B
authors: Wirk
authors: Ginna G
authors: GG
authors: Laport
authors: Silvia
authors: S
authors: Montoto
authors: David G
authors: DG
authors: Maloney
authors: Hillard M
authors: HM
authors: Lazarus
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
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