Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation

Abstract

We report the outcome of reduced-intensity allogeneic progenitor cell transplantation (alloPCT) for 188 patients with lymphoma from the Working Party Lymphoma of the European Group for Blood and Bone Marrow Transplantation (EBMT). The median age of the patients was 40 years, the median number of prior treatment courses was 3, and 48% of patients had undergone a prior autologous transplantation. Eighty-four percent of the patients received conditioning with fludarabinebased regimens and 10% with the BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) protocol. Full donor chimerism was confirmed in 71% of 100 patients assessed. Acute graft-versus-host disease (GVHD) developed in 37% of patients and chronic GVHD in 17%. A disease response to donor leukocyte infusion (DLI) was seen in 10 of 14 patients. With a median follow-up of 283 days, the overall survival rates at 1 and 2 years were 62% and 50%, respectively. The 100-day and 1-year transplantationrelated mortality (TRM) rates were 12.8% and 25.5%, respectively, and were significantly worse for older patients. The probability of disease progression at 1 year for patients with chemoresistant and chemosensitive disease were 75% and 25%, respectively (P ‫؍‬ .001). The progressionfree survival at 1 year was 46% and was significantly better for those with chemosensitive disease, Hodgkin disease (

Current role of allogeneic stem cell transplantation in follicular lymphoma

“…16,17 So far, published data have shown that patients with similarly treated low-grade non-Hodgkin's lymphoma undergoing T-cell depleted transplants have (compared to similarly treated patients with aggressive non-Hodgkin's lymphoma) a superior event-free survival and a lower relapse rate compared to patients with aggressive histologies. 15 16 This observation is in contrast with the data published in this issue showing that patients in CR and PR had similar outcomes. We might conclude that T-cell depletion does not affect disease progression in FL patients in CR before transplant and that it can contribute to significant decreases in GVHD-related toxicity and mortality.…”

“…14 Subsequent studies showed that FL has the most favorable outcome among lymphoprolyferative disorders. [15][16][17] In a cohort of patients enrolled in a multicenter Italian trial, the 3-year overall survival of patients with FL was 69%, similar to the survival rate reported by Vigouroux et al in this issue of the journal. 18 The optimal conditioning regimen has not been defined yet: fludarabine-based chemotherapy seems suitable because it combines both immunosuppression and anti-tumor activity.…”

Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

“…[1][2][3] RIC regimens also have been investigated in patients with aggressive lymphomas: Most of those studies included various B-cell and T-cell histotypes, and the estimated 3-year PFS rates have been 15% to 20% in patients with chemoresistant disease and 45% to 55% in patients with chemosensitive disease. [4][5][6][7] Chemosensitivity is 1 of the most important prognostic factors affecting final outcomes in patients who receive myeloablative conditioning, and is also important for patients who receive RIC regimens. We recently demonstrated better overall survival (OS) and PFS in patients with lymphoma who underwent an allograft in complete remission compared with the survival of patients who underwent transplantation in partial remission or with refractory disease.…”

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

“…1 In these patients, salvage chemotherapy followed by high-dose chemotherapy (HDC) with autologous stem cells has become the gold standard treatment producing longterm remissions in approximately 40-50% of relapsed patients [2][3][4] and in up to 25-30% of those with primary refractory disease. 5,6 Nevertheless, a substantial number of patients will also relapse after HDC and will require further therapy. In this setting, an allo-SCT folllowing reduced intensity conditioning or nonmyeloablative regimens (NMA) has been shown to be feasible [6][7][8][9][10][11][12][13][14] and superior in terms of survival and PFS, when compared with other therapeutic options.…”