Outcome of Lower-Intensity Allogeneic Transplantation in Non-Hodgkin Lymphoma after Autologous Transplantation Failure

César O. Freytes, Mei Jie Zhang, Jeanette Carreras, Linda J. Burns, Robert Peter Gale, Luis Isola, Miguel Angel Perales, Matthew Seftel, Julie M. Vose, Alan M. Miller, John Gibson, Thomas G. Gross, Philip A. Rowlings, David J. Inwards, Santiago Pavlovsky, Rodrigo Martino, David I. Marks, Gregory A. Hale, Sonali M. Smith, Harry C. SchoutenSimon Slavin, Thomas R. Klumpp, Hillard M. Lazarus, Koen van Besien, Parameswaran N. Hari

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1255-1264
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number8
DOIs
StatePublished - Aug 2012

Keywords

  • Allogeneic
  • Reduced-intensity
  • Relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Freytes, C. O., Zhang, M. J., Carreras, J., Burns, L. J., Gale, R. P., Isola, L., Perales, M. A., Seftel, M., Vose, J. M., Miller, A. M., Gibson, J., Gross, T. G., Rowlings, P. A., Inwards, D. J., Pavlovsky, S., Martino, R., Marks, D. I., Hale, G. A., Smith, S. M., ... Hari, P. N. (2012). Outcome of Lower-Intensity Allogeneic Transplantation in Non-Hodgkin Lymphoma after Autologous Transplantation Failure. Biology of Blood and Marrow Transplantation, 18(8), 1255-1264. https://doi.org/10.1016/j.bbmt.2011.12.581