Outcome of Lower-Intensity Allogeneic Transplantation in Non-Hodgkin Lymphoma after Autologous Transplantation Failure
Por:
Freytes, CO, Zhang, MJ, Carreras, J, Burns, LJ, Gale, RP, Isola, L, Perales, MA, Seftel, M, Vose, JM, Miller, AM, Gibson, J, Gross, TG, Rowlings, PA, Inwards, DJ, Pavlovsky, S, Martino, R, Marks, DI, Hale, GA, Smith, SM, Schouten, HC, Slavin, S, Klumpp, TR, Lazarus, HM, van Besien, K, Hari, PN
Publicada:
1 ago 2012
Resumen:
We studied the outcome of allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning regimens (reduced-intensity conditioning and nonmyeloablative) in patients with non-Hodgkin lymphoma who relapsed after autologous hematopoietic stem cell transplantation. Nonrelapse mortality, lymphoma progression/relapse, progression-free survival (PFS), and overall survival were analyzed in 263 patients with non-Hodgkin lymphoma. All 263 patients had relapsed after a previous autologous hematopoietic stem cell transplantation and then had undergone allogeneic hematopoietic stem cell transplantation from a related (n = 26) or unrelated (n = 237) donor after reduced-intensity conditioning (n = 128) or nonmyeloablative (n = 135) and were reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2006. The median follow-up of survivors was 68 months (range, 3-111 months). Three-year nonrelapse mortality was 44% (95% confidence interval [CI], 37%-50%). Lymphoma progression/relapse at 3 years was 35% (95% CI, 29%-41%). Three-year probabilities of PFS and overall survival were 21% (95% CI, 16%-27%) and 32% (95% CI, 27%-38%), respectively. Superior Karnofsky Performance Score, longer interval between transplantations, total body irradiation-based conditioning regimen, and lymphoma remission at transplantation were correlated with improved PFS. Allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning is associated with significant nonrelapse mortality but can result in long-term PFS. We describe a quantitative risk model based on pretransplantation risk factors to identify those patients likely to benefit from this approach. Biol Blood Marrow Transplant 18: 1255-1264 (2012) (C) 2012 American Society for Blood and Marrow Transplantation
Filiaciones:
Freytes, CO:
Univ Texas Hlth Sci Ctr San Antonio, S Texas Vet Hlth Care Syst, San Antonio, TX 78229 USA
Zhang, MJ:
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Carreras, J:
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Burns, LJ:
Univ Minnesota, Med Ctr, Minneapolis, MN 55455 USA
Gale, RP:
Celgene Corp, Summit, NJ USA
Isola, L:
Mt Sinai Hosp, New York, NY 10029 USA
Perales, MA:
Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
Seftel, M:
Univ Manitoba, Winnipeg, MB, Canada
Vose, JM:
Univ Nebraska Med Ctr, Omaha, NE USA
Miller, AM:
Baylor Univ, Med Ctr, Dallas, TX USA
Gibson, J:
Royal Prince Alfred Hosp, Camperdown, NSW 2050, Australia
Gross, TG:
Ohio State Univ, Nationwide Childrens Hosp, Columbus, OH 43210 USA
Rowlings, PA:
Calvary Mater Hosp, Waratah, Australia
Inwards, DJ:
Mayo Clin, Rochester, MN USA
Pavlovsky, S:
Fundaleu, Buenos Aires, DF, Argentina
Martino, R:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Marks, DI:
Bristol Childrens Hosp, Bristol, Avon, England
Hale, GA:
Univ S Florida, All Childrens Hosp, St Petersburg, FL 33701 USA
Smith, SM:
Univ Chicago Hosp, Chicago, IL 60637 USA
Schouten, HC:
Univ Hosp Maastricht, Maastricht, Netherlands
Slavin, S:
Hadassah Med Ctr, Tel Aviv, Israel
Klumpp, TR:
Temple Univ, BMT Program, Philadelphia, PA 19122 USA
Lazarus, HM:
Univ Hosp Cleveland, Case Med Ctr, Cleveland, OH 44106 USA
van Besien, K:
Univ Chicago Hosp, Chicago, IL 60637 USA
Hari, PN:
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Green Accepted, Hybrid Gold
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