Myeloablative allogeneic hematopoietic stem cell transplantation in patients who experience relapse after autologous stem cell transplantation for lymphoma: a report of the International Bone Marrow Transplant Registry
César O Freytes, Fausto R Loberiza, J Douglas Rizzo, Asad Bashey, Christopher N Bredeson, Mitchell S Cairo, Robert Peter Gale, Mary M Horowitz, Thomas R Klumpp, Rodrigo Martino, Philip L McCarthy, Arturo Molina, Santiago Pavlovsky, Andrew L Pecora, Derek S Serna, Tsuong Tsai, Mei-Jie Zhang, Julie M Vose, Hillard M Lazarus, Koen van Besien, Lymphoma Working Committee of the International Bone Marrow Transplant Registry, César O Freytes, Fausto R Loberiza, J Douglas Rizzo, Asad Bashey, Christopher N Bredeson, Mitchell S Cairo, Robert Peter Gale, Mary M Horowitz, Thomas R Klumpp, Rodrigo Martino, Philip L McCarthy, Arturo Molina, Santiago Pavlovsky, Andrew L Pecora, Derek S Serna, Tsuong Tsai, Mei-Jie Zhang, Julie M Vose, Hillard M Lazarus, Koen van Besien, Lymphoma Working Committee of the International Bone Marrow Transplant Registry
Abstract
Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.
Source: PubMed