Allogeneic or autologous bone marrow transplantation (BMT) for non-Hodgkin’s lymphoma (NHL): results of a provincial strategy

Summary:Allogeneic stem cell transplantation has an underappreciated role in the management of intermediate-grade non-Hodgkin's lymphoma. It provides several advantages over autologous stem cell transplantation including provision of a lymphoma-free graft, reduced rates of secondary myelodysplastic syndrome and leukemia, and a potentially curative graft-versus-lymphoma effect. When applied to chemosensitive patients, the lower relapse rates and reasonable long-term outcomes make allogeneic transplantation a promising therapy to pursue. Patient populations, such as those with bone marrow involvement or very high-risk disease, can be identified as having suboptimal outcomes after autotransplantation and may benefit from such an approach. While the exact role of allogeneic stem cell transplantation remains to be determined, broad recommendations can be suggested for the management of patients with intermediate-grade lymphoma. New approaches to allogeneic transplantation, including the use of matched-unrelated donors and reduced-intensity conditioning regimens, may expand the applicability of this potentially curative modality. Bone Marrow Transplantation (2003) 31, 953-960.

“…20,21,23,38,43 Overall, the above outcomes reported for aggressive nonHodgkin's lymphoma are quite respectable and not dissimilar to that seen after autoSCT.…”

Section: Results Of Allosctmentioning

confidence: 57%

Why aren't we performing more allografts for aggressive non-Hodgkin's lymphoma?

Mollee

Lazarus

Lipton

2003

“…In all, 37 consecutive patients with low-or intermediate-grade NHL who received a matched related allogeneic bone marrow or peripheral stem cell transplant at Princess Margaret Hospital with bu-cy as the preparative regimen between 1 January 1989 and 30 June 1999 were included in this study. Patients with a related donor were offered allogeneic BMT if they were not eligible for autologous transplantation based on bone marrow involvement 12 or based on physician and patient preference.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…In cases of persistent marrow involvement or inadequate stem cell harvest, allogeneic transplant was done using a number of different preparative regimens if there was a matched related donor. 12 All patients transplanted in this province between 1986 and 1997 were included in the final analysis. In all, 385 patients received an autologous and 44 an allogeneic transplant.…”

mentioning

confidence: 99%

“…However, the relapse rate was lower after allogeneic transplantation (41 vs 6%, P ¼ 0.0006). 12 At Princess Margaret Hospital allogeneic transplantation was first offered to patients with NHL, who were not eligible for an autologous transplant because of residual marrow involvement or failure to mobilize a graft. A nonradiation containing regimen with busulfan-cyclophosphamide (bu-cy) was chosen because of reports of efficacy 13 and acceptable toxicity profiles 14,15 in high-risk patients with hemopoietic malignancies and to allow uniform treatment of all patients, including those who had been exposed to dose-limiting radiation prior to transplant.…”

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confidence: 99%

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Busulfan and cyclophosphamide as a preparative regimen for allogeneic blood and marrow transplantation in patients with non-Hodgkin's lymphoma

Kiss

Panzarella

Messner

et al. 2003

Self Cite

Summary:This study reports on overall and recurrence-free survival (OS and RFS) of 37 consecutive patients with low-and intermediate-grade NHL receiving a related donor allogeneic BMT using a nonradiation-containing preparative regimen. In addition, transplant-related toxicity and factors influencing outcome are discussed. The preparative regimen consisted of busulfan and cyclophosphamide. Median patient age was 44 years (range 20-55). In all, 18 were female. Median follow-up of surviving patients from BMT was 4.2 years. A total of 25 patients had low-grade, and 12 intermediate grade NHL. Most patients (89%) were treated with at least two different chemotherapy regimens prior to BMT. In all, 22 patients (59%) were transplanted in partial remission, 15 (41%) in complete remission. OS at 12 months was 89% (95% confidence interval (CI) of 79-99%) and 79% (64-93%) at 60 months. RFS at 12 months was 86% (75-97%) and at 5 years 70% (54-86%). Four patients (11%) relapsed. Seven patients (19%) died, six because of treatmentrelated toxicity and one with relapse. Univariate analysis showed improved OS for younger patients and patients of female gender, suggesting that allogeneic BMT using busulfan-cyclophosphamide as a preparative regimen can achieve disease control and possibly cure patients with NHL particularly younger ones.

“…16,17 On the contrary, some other studies suggested a potential GVL effect, however, at a cost of greater non-relapse mortality (NRM) compared with the autologous setting. [18][19][20] The data to suggest that DLI can facilitate response in relapsed DLBCL after allo-HCT is limited, with a small number of patients having been included in reported studies. In the study by Morris et al, 21 only three of nine patients with high-grade NHL responded to DLI compared with 6 of 10 patients with low-grade NHL.…”

Section: Introductionmentioning

confidence: 99%

The role of allogeneic haematopoietic progenitor cell transplantation in patients with diffuse large B-cell non-Hodgkin lymphomas (DLBCL)

Papageorgiou

Cwynarski

Kottaridis

2013

Despite the undoubted improvement in the prognosis of patients with diffuse large B-cell lymphomas (DLBCLs) with the addition of rituximab in the front-line treatment, a significant proportion of patients still relapse. Salvage immune-chemotherapy followed by high-dose therapy with autologous haematopoietic cell transplantation (auto-HCT) remains the treatment of choice for such patients, especially in those who demonstrate chemosensitive disease. In recent years, allogeneic haematopoietic cell transplantation (allo-HCT) has increasingly been used for patients who are resistant to salvage treatment or relapse after an auto-HCT. Strategies using reduced intensity conditioning regimens have allowed application of this approach to a broader range of patients. PFS is up to 55% with a risk of relapse up to 80% depending on different studies. In multivariate analysis, several factors have been associated with favourable outcome including chemosensitivity of the disease, younger age and Karnofsky performance status at the time of the transplant being the strongest ones. DLIs have shown to induce durable responses in relapsed or progressed disease; however, its role remains controversial as the results are inferior to the responses seen in other haematological malignancies. More recently, the addition of MoAbs in the non-myeloablative conditioning regimens has shown encouraging results. In conclusion, allo-HCT is a feasible option in selective patients with chemosensitive DBCL, as it reduces the risk of relapse; however, this is achieved at the cost of significant non-relapse mortality.