Allogeneic Stem-Cell Transplantation As Salvage Therapy for Patients With Diffuse Large B-Cell Non-Hodgkin's Lymphoma Relapsing After an Autologous Stem-Cell Transplantation: An Analysis of the European Group for Blood and Marrow Transplantation Registry
Por:
van Kampen, RJW, Canals, C, Schouten, HC, Nagler, A, Thomson, KJ, Vernant, JP, Buzyn, A, Boogaerts, MA, Luan, JJ, Maury, S, Milpied, NJ, Jouet, JP, Ossenkoppele, GJ, Sureda, A
Publicada:
1 abr 2011
Resumen:
Purpose
To analyze the outcome, including nonrelapse mortality (NRM), relapse rate (RR), progression-free survival (PFS), and overall survival (OS), of patients with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) relapsed after an autologous stem-cell transplantation (ASCT) and treated with an allogeneic stem-cell transplantation (allo-SCT).
Patients and Methods
The European Group for Blood and Marrow Transplantation database was scanned for a first allo-SCT in relapsed DLBCL after a previous ASCT between 1997 and 2006. Other inclusion criteria were age at allo-SCT >= 18 years and availability of an HLA-identical sibling or a matched unrelated donor. A total of 101 patients (57 males; median age, 46 years) were included. Median follow-up for survivors was 36 months.
Results
Myeloablative conditioning regimen was used in 37 patients and reduced intensity conditioning (RIC) was used in 64 patients. Three-year NRM was 28.2% (95% CI, 20% to 39%), RR was 30.1% (95% CI, 22% to 41%), PFS was 41.7% (95% CI, 32% to 52%), and OS was 53.8% (95% CI, 44% to 64%). NRM was significantly increased in patients >= 45 years (P = .01) and in those with an early relapse (< 12 months) after ASCT (P = .01). RR was significantly higher in refractory patients (P = .03). A time interval to relapse after ASCT of < 12 months was associated with lower PFS (P = .03). The use of RIC regimens was followed by a trend to a lower NRM (P = .1) and a trend to a higher RR (P = .1), with no differences in PFS and OS. No differences were seen between HLA-identical siblings and matched unrelated donors.
Conclusion
Allo-SCT in relapsed DLBCL after ASCT is a promising therapeutic modality. Patients with a long remission after ASCT and with sensitive disease at allo-SCT are the best candidates for this approach. J Clin Oncol 29: 1342-1348. (C) 2011 by American Society of Clinical Oncology
Filiaciones:
van Kampen, RJW:
Univ Hosp Maastricht, Maastricht, Netherlands.
Sureda, A:
Hosp Santa Creu & Sant Pau, Dept Hematol, Barcelona 08026, Spain
Hop La Pitie Salpetriere, Paris, France.
Hop Necker Enfants Malad, Paris, France.
EBMT Data Off, Paris, France.
Hop Henri Mondor, F-94010 Creteil, France.
CHU Bordeaux, Pessac, France.
Hop Claude Huriez, Lille, France.
Hosp Valle De Hebron, Barcelona, Spain.
Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel.
Univ Coll London Hosp, London, England.
Univ Hosp Gasthuisberg, B-3000 Louvain, Belgium.
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