title: Comparison of non-myeloablative conditioning regimens for lymphoproliferative disorders.
abstract: Hematopoietic cell transplantation (HCT) with non-myeloablative (NMA) conditioning for lymphoproliferative diseases (LD) includes fludarabine with and without low-dose TBI. Transplant outcomes were compared among patients aged ⩾40 years with LD who received a HCT with TBI (N=382) or no-TBI (N=515) NMA from 2001 to 2011. The groups were comparable except for donor, graft, prophylaxis for GVHD, disease status and year of HCT. Cumulative incidences of grades II-IV GVHD at 100 days were 29% and 20% (P=0.001) and of chronic GVHD at 1 year were 54% and 44% (P=0.004) for TBI and no-TBI, respectively. Multivariate analysis of progression/relapse, treatment failure and mortality showed no outcome differences by conditioning. Full donor chimerism at day 100 was observed in 82% vs 64% in the TBI and no-TBI groups, respectively (P=0.006). Subsets of the four most common conditioning/GVHD prophylaxis combinations demonstrated higher rates of grades II-IV acute (P<0.001) and chronic GVHD (P<0.001) among recipients of TBI-mycophenolate mofetil (MMF) compared with other combinations. TBI-based NMA conditioning induces faster full donor chimerism, but overall survival outcomes are comparable to no-TBI regimens. Combinations of TBI and MMF are associated with higher rates of GVHD without impact on survival outcomes in patients with LD.
authors.affiliation: 1] Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA [2] Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hong
authors.affiliation: 1] Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA [2] Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J
authors.initials: J
authors.lastname: Le-Rademacher
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Artz
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: McCarthy
authors.affiliation: 1] Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA [2] Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Logan
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Pasquini
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014916:Whole-Body Irradiation