title: Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation.
abstract: There are limited data to guide the choice of high-dose therapy (HDT) regimen before autologous hematopoietic cell transplantation (AHCT) for patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). We studied 4917 patients (NHL, n = 3905; HL, n = 1012) who underwent AHCT from 1995 to 2008 using the most common HDT platforms: carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) (n = 1730); cyclophosphamide, BCNU, and etoposide (CBV) (n = 1853); busulfan and cyclophosphamide (BuCy) (n = 789); and total body irradiation (TBI)-containing treatment (n = 545). CBV was divided into CBV(high) and CBV(low) based on BCNU dose. We analyzed the impact of regimen on development of idiopathic pulmonary syndrome (IPS), transplantation-related mortality (TRM), and progression-free and overall survival. The 1-year incidence of IPS was 3% to 6% and was highest in recipients of CBV(high) (hazard ratio [HR], 1.9) and TBI (HR, 2.0) compared with BEAM. One-year TRM was 4% to 8%, respectively, and was similar between regimens. Among patients with NHL, there was a significant interaction between histology, HDT regimen, and outcome. Compared with BEAM, CBV(low) (HR, .63) was associated with lower mortality in follicular lymphoma (P < .001), and CBV(high) (HR, 1.44) was associated with higher mortality in diffuse large B cell lymphoma (P = .001). For patients with HL, CBV(high) (HR, 1.54), CBV(low) (HR, 1.53), BuCy (HR, 1.77), and TBI (HR, 3.39) were associated with higher mortality compared with BEAM (P < .001). The impact of specific AHCT regimen on post-transplantation survival is different depending on histology; therefore, further studies are required to define the best regimen for specific diseases.
authors: Division of Hematology/Oncology, Massachusetts General Hospita1, Boston, MA.
authors: Yi-Bin
authors: YB
authors: Chen
authors: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA.
authors: Andrew A
authors: AA
authors: Lane
authors: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.
authors: Brent
authors: B
authors: Logan
authors: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors: Xiaochun
authors: X
authors: Zhu
authors: Department of Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ.
authors: Görgün
authors: G
authors: Akpek
authors: Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors: Mahmoud
authors: M
authors: Aljurf
authors: Section of Hematology/Oncology, University of Chicago Hospitals, Chicago, IL.
authors: Andrew
authors: A
authors: Artz
authors: Department of Medicine, The Ottawa Hospital Blood & Marrow Transplant Program, Ottawa, Ontario, Canada.
authors: Christopher N
authors: CN
authors: Bredeson
authors: Division of Pediatric Oncology, Bone Marrow Transplant Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD.
authors: Kenneth R
authors: KR
authors: Cooke
authors: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA.
authors: Vincent T
authors: VT
authors: Ho
authors: Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
authors: Hillard M
authors: HM
authors: Lazarus
authors: Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors: Richard
authors: R
authors: Olsson
authors: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors: Wael
authors: W
authors: Saber
authors: Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.
authors: Philip
authors: P
authors: McCarthy
authors: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research (CIBMTR®), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors: Marcelo C
authors: MC
authors: Pasquini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002066:Busulfan / Q000627:therapeutic use; D002330:Carmustine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan; D008558:Melphalan; D002330:Carmustine
keywords: Autologous transplantation; Idiopathic pneumonia syndrome; Lymphoma