title: Allogeneic Transplantation for Relapsed Waldenström Macroglobulinemia and Lymphoplasmacytic Lymphoma.
abstract: Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) is characterized by lymphoplasmacytic proliferation, lymph node and spleen enlargement, bone marrow involvement, and IgM production. Treatment varies based on the extent and biology of disease. In some patients, the use of allogeneic hematopoietic cell transplantation (alloHCT) may have curative potential. We evaluated long-term outcomes of 144 patients who received adult alloHCT for WM/LPL. Data were obtained from the Center for International Blood and Marrow Transplant Research database (2001 to 2013). Patients received myeloablative(n = 67) or reduced-intensity conditioning (RIC; n = 67). Median age at alloHCT was 53 years, and median time from diagnosis to transplantation was 41 months. Thirteen percent (n = 18) failed prior autologous HCT. About half (n = 82, 57%) had chemosensitive disease at the time of transplantation, whereas 22% had progressive disease. Rates of progression-free survival, overall survival, relapse, and nonrelapse mortality at 5 years were 46%, 52%, 24%, and 30%, respectively. Patients with chemosensitive disease and better pretransplant disease status experienced significantly superior overall survival. There were no significant differences in progression-free survival based on conditioning (myeloablative, 50%, versus RIC, 41%) or graft source. Conditioning intensity did not impact treatment-related mortality or relapse. The most common causes of death were primary disease and graft-versus-host disease (GVHD). AlloHCT yielded durable survival in select patients with WM/LPL. Strategies to reduce mortality from GVHD and post-transplant relapse are necessary to improve this approach.
authors: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Robert F
authors: RF
authors: Cornell
authors: Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors: Veronika
authors: V
authors: Bachanova
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: andsouza@mcw.edu.
authors: Anita
authors: A
authors: D'Souza
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Kwang
authors: K
authors: Woo-Ahn
authors: Department of Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Michael
authors: M
authors: Martens
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Jiaxing
authors: J
authors: Huang
authors: Blood and Marrow Transplant, Spectrum Health, Grand Rapids, Michigan.
authors: A Samer
authors: AS
authors: Al-Homsi
authors: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors: Saurabh
authors: S
authors: Chhabra
authors: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors: Edward
authors: E
authors: Copelan
authors: Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors: Miguel-Angel
authors: MA
authors: Diaz
authors: Texas Transplant Institute, San Antonio, Texas.
authors: Cesar O
authors: CO
authors: Freytes
authors: Hematology Research Center, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
authors: Robert Peter
authors: RP
authors: Gale
authors: Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas.
authors: Siddhartha
authors: S
authors: Ganguly
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mehdi
authors: M
authors: Hamadani
authors: Division of Hematology and Blood & Marrow Transplantation, University of Kentucky Markey Cancer Center, Lexington, Kentucky.
authors: Gerhard
authors: G
authors: Hildebrandt
authors: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
authors: Rammurti T
authors: RT
authors: Kamble
authors: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida.
authors: Mohamed
authors: M
authors: Kharfan-Dabaja
authors: Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
authors: Tamila
authors: T
authors: Kindwall-Keller
authors: Seidman Cancer Center, University Hospital Case Medical Center, Cleveland, Ohio.
authors: Hillard M
authors: HM
authors: Lazarus
authors: Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors: David I
authors: DI
authors: Marks
authors: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida.
authors: Taiga
authors: T
authors: Nishihori
authors: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
authors: Richard F
authors: RF
authors: Olsson
authors: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Ayman
authors: A
authors: Saad
authors: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors: Saad
authors: S
authors: Usmani
authors: John Theurer Cancer Center at Hackensack UMC, Hackensack, New Jersey.
authors: David H
authors: DH
authors: Vesole
authors: Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, University of Maryland Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland.
authors: Jean
authors: J
authors: Yared
authors: Department of Medicine, Weill Cornell Medical College, New York, New York.
authors: Tomer
authors: T
authors: Mark
authors: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Yago
authors: Y
authors: Nieto
authors: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Parameswaran
authors: P
authors: Hari
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D061665:Time-to-Treatment; D019172:Transplantation Conditioning / Q000379:methods / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D008258:Waldenstrom Macroglobulinemia / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Allogeneic stem cell transplant; Relapsed lymphoma