Impact of pretransplantation conditioning regimens on outcomes of allogeneic transplantation for chemotherapy-unresponsive diffuse large b cell lymphoma and grade iii follicular lymphoma

Mehdi Hamadani, Wael Saber, Kwang Woo Ahn, Jeanette Carreras, Mitchell S. Cairo, Timothy S. Fenske, Robert Peter Gale, John Gibson, Gregory A. Hale, Parameswaran N. Hari, Jack W. Hsu, David J. Inwards, Rammurti T. Kamble, Anderas Klein, Dipnarine Maharaj, David I. Marks, David A. Rizzieri, Bipin N. Savani, Harry C. Schouten, Edmund K. WallerBaldeep Wirk, Ginna G. Laport, Silvia Montoto, David G. Maloney, Hillard M. Lazarus

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50 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)746-753
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number5
DOIs
StatePublished - May 2013

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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