An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation

Abstract

LymphomaAn EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation AJ Peniket, MC Ruiz de Elvira, G Taghipour, C Cordonnier, E Gluckman, T years; Burkitt's lymphoma 37.1%; and Hodgkin's disease 24.7% years. These outcomes are relatively poor because of the high procedure-related mortality associated with these procedures, particularly in patients with Hodgkin's disease (51.7% actuarial procedure-related mortality at 4 years). Multivariate analysis showed that for all lymphomas apart from Hodgkin's disease, status at transplantation significantly affected outcome. A matched analysis was performed: for all categories of lymphoma, OS was better for autologous than for allogeneic transplantation. Relapse rate was better in the allogeneic group for low-, intermediate-and high-grade, and lymphoblastic NHL. It was equivalent for Burkitt's lymphoma and worse in the allogeneic group for Hodgkin's disease. Allogeneic transplantation appears to be superior to autologous procedures in terms of producing a lower relapse rate. The toxicity of allogeneic procedures must however be reduced before this translates into an improvement in OS.

Autologous SCT with a dose-reduced BU and CY regimen in older patients with non-Hodgkin's lymphoma

“…These have included BCNU or TBI combined with etoposide and CY, TBI with etoposide and CY, carmustine, cytarabine, CY and etoposide (BEAC), or BCNU, etoposide, ara-c and melphalan (BEAM). [19][20][21][22] Disease-free survival probabilities of 28-60% have been reported after autologous transplantation using these regimens. No randomized studies have compared these conditioning regimens.…”

Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma

“…Allotransplantation may be curative for some patients because of the antilymphoma effect of the graft, however, the transplantrelated mortality (TRM) rate of myeloablative (MA) HSCT is reported to be 25-50%. [1][2][3][4][5] Infections are frequent complications following HSCT and vary widely with the donor type, conditioning regimen, the immunosuppressive therapy used to prevent and treat GVHD as well as host factors such as age, underlying malignancy and presence of comorbidities. [6][7][8][9][10][11][12] Non-myeloablative (NMA) conditioning has been explored to decrease acute toxicities and shorten neutropenia and yet maintain a GVL effect.…”

Outcomes of reduced-intensity conditioning allo-SCT for Hodgkin's lymphoma: a national review by the Canadian Blood and Marrow Transplant Group

“…Myeloablative allo-SCT in HL has been used in advanced phases of the disease, but there have been significant concerns since the treatment-related mortality often exceeded 50% and relapses were not uncommon. 1 The presence of a clinically significant graft-vs-HL effect had never been clearly shown until more recent reports described signs of an antitumour effect after donor lymphocyte infusion. 2,3 In addition to this demonstration of immune-mediated antitumour effect, the early treatment-related mortality of allogeneic transplantation has improved with the use of reduced-intensity conditioning allo-SCT (RIC-allo) strategies.…”