Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

Kahl, Christoph; Storer, Barry E.; Sandmaier, Brenda M.; Mielcarek, Marco; Maris, Michael B.; Blume, Karl G.; Niederwieser, Dietger; Chauncey, Thomas R.; Forman, Stephen J.; Agura, Edward; Leis, José F.; Bruno, Benedetto; Langston, Amelia; Pulsipher, Michael A.; McSweeney, Peter A.; Wade, James C.; Epner, Elliot; Petersen, Finn; Bethge, Wolfgang; Maloney, David G.; Storb, Rainer

doi:10.1182/blood-2007-03-078592

Cited by 153 publications

(127 citation statements)

References 24 publications

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“…Although the 20-30% PFS plateaus observed seem to be inferior to 3-year PFS rates ranging from 25 to 60% in registry studies on first allotransplants in HL, TCL and follicular lymphoma, 19,20,[25][26][27] this outcome is in line with circumstantial evidence suggesting that these three entities are more susceptible to GVL than aggressive B-cell lymphoma. 24,28 In addition, the finding that in many patients chronic GVHD was absent after alloHSCT_1 but not after alloHSCT_2 is consistent with the conclusion that a second allotransplant might induce an effective allo-response in patients in whom it failed to appear after the first transplant, even if we were not able to show a direct correlation between chronic GVHD and disease control after alloHSCT_2.…”

Section: Discussionsupporting

confidence: 71%

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

Horstmann

Boumendil

Finke

et al. 2015

Bone Marrow Transplant

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The aim of this registry-based retrospective study was to analyze the outcome of second allogeneic hematopoietic SCT (alloHSCT_2) performed in patients with lymphoma who had relapsed after a first allogeneic transplant (alloHSCT_1). Patients ⩾ 18 years who had received an alloHSCT_2 for lymphoma relapse between 2000 and 2011 were eligible. One hundred and forty patients were identified. The diagnosis was Hodgkin lymphoma (HL) in 31%, diffuse large B-cell lymphoma in 14%, T-cell lymphoma in 12%, indolent lymphoma in 19%, mantle cell lymphoma in 16% and other lymphomas in 8% of the patients. The median interval from alloHSCT_1 to alloHSCT_2 was 19 (range 4-116) months. Disease status at alloHSCT_2 was chemosensitive in 46%, refractory in 43% and unknown in 11% of the patients. Three-year PFS, OS, relapse incidence and nonrelapse mortality were 19%, 29%, 58% and 23%, respectively. PFS and OS were significantly affected by refractory disease at alloHSCT_2 and a short interval between alloHSCT_1 and alloHSCT_2. Long-term PFS was observed across all lymphoma subsets except for aggressive B-cell lymphoma. In conclusion, alloHSCT_2 is feasible and can result in long-term disease control in patients with lymphoma recurrence after alloHSCT_1, in particular if relapse occurs late and is chemosensitive.

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Section: Discussionsupporting

confidence: 71%

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

Horstmann

Boumendil

Finke

et al. 2015

Bone Marrow Transplant

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“…Antitumor responses may require extended periods of time, with some patients achieving complete remission more than 1 year after HSCT. GVT activity may also vary in intensity depending on the immunogenicity of the tumors and the respective proliferation rates of tumor cells and donor immune cells [10].…”

Section: Graft-versus-tumor Effectmentioning

confidence: 99%

“…Graft-versus-tumor effects were particularly impressive in patients with indolent or mantle cell lymphoma, as well as in those with chemosensitive aggressive lymphomas [10]. Further, two recent reports demonstrated that some patients with Hodgkin's lymphoma relapsing after autologous HSCT could be salvaged with nonmyeloablative/RIC allo-HSCT [34].…”

Section: Lymphomasmentioning

confidence: 99%

Allogeneic hematopoietic stem cell transplantation (HSCT) after reduced intensity conditioning

Servais¹,

Baron²,

Béguin³

2011

Transfusion and Apheresis Science

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a b s t r a c tAllogeneic hematopoietic stem cell transplantation (HSCT) following myeloablative (conventional) conditioning regimen is associated with a high incidence of transplant-related morbidity and mortality, limiting its use to younger patients without medical co-morbidities. Over the past few years, it has become more evident that the alloreactivity of transplanted donor immunocompetent cells against host tumor cells (graft-versus-tumor effects, GVT effects) plays a major role in eradicating malignancies after allogeneic HSCT. Based on these observations, several groups of investigators have developed reduced intensity conditioning (RIC) regimens allowing patients who are ineligible for conventional HSCT to benefit from the potentially curative GVT effects of allogeneic transplantation. Retrospective studies have suggested that, in comparison with myeloablative allogeneic HSCT, in patients aged 40-60 years, RIC HSCT was associated with a higher risk of relapse but a lower incidence of transplant-related mortality leading to similar progression-free and overall survivals. Prospective studies are ongoing to define which patients might most benefit from RIC HSCT, and to increase the anti-tumoral activity of the procedure while reducing the incidence and the severity of acute graft-versus-host disease (GVHD). In this article, we review the current status and perspectives of RIC HSCT.

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“…As mentioned above, this problem has been approached through the development of nonmyeloablative preparative regimens. A recent review 24 of a large study on 834 patients transplanted following preparation with TBI at a dose of 200 cGy with or with out fludarabine at 30 mg/m 2 /day Â 3 days included 152 patients with AML. The relapse rate per patient year was 33% for patients transplanted in CR1 and 37% for patients transplanted in second or higher CR.…”

Section: Preparative Regimensmentioning

confidence: 99%

Current status of blood and marrow transplantation for patients with AML

Messner

2008

Bone Marrow Transplant

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During the past decade it has become apparent that patients can be transplanted successfully after preparation with regimens of reduced intensity. Reduced intensity preparations have resulted in lower morbidity and mortality during the pre-engraftment period, but have not reduced later occurring infections, GVHD and relapse. Outcome-determining risk factors that characterize patients at diagnosis as well as during their course include age, cytogenetic configuration, hematopoietic elements and a previous history of myelodysplasia or cytoreductive therapy for a pre-existing malignancy. These factors are complemented by the response to induction therapy and subsequent treatments as well as by the duration of the response. More recently, gene expression profiling of leukemic cells has added a new dimension to simultaneously assessed biological risk factors that may ultimately lead to individuation of therapy.

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Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

Cited by 153 publications

References 24 publications

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

Allogeneic hematopoietic stem cell transplantation (HSCT) after reduced intensity conditioning

Current status of blood and marrow transplantation for patients with AML

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