Myeloablative allogeneic hematopoietic stem cell transplantation in patients who experience relapse after autologous stem cell transplantation for lymphoma: a report of the International Bone Marrow Transplant Registry

Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effe...

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Bibliographic Details
Published in:Blood 2004-12, Vol.104 (12), p.3797-3803
Main Authors: Freytes, César O., Loberiza, Fausto R., Rizzo, J. Douglas, Bashey, Asad, Bredeson, Christopher N., Cairo, Mitchell S., Gale, Robert Peter, Horowitz, Mary M., Klumpp, Thomas R., Martino, Rodrigo, McCarthy, Philip L., Molina, Arturo, Pavlovsky, Santiago, Pecora, Andrew L., Serna, Derek S., Tsai, Tsuong, Zhang, Mei-Jie, Vose, Julie M., Lazarus, Hillard M., van Besien, Koen
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Disease Progression
Female
Hematologic and hematopoietic diseases
Hematopoietic Stem Cell Transplantation - methods
Hematopoietic Stem Cell Transplantation - mortality
Humans
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lymphoma - mortality
Lymphoma - therapy
Male
Medical sciences
Middle Aged
Multivariate Analysis
Myeloablative Agonists - therapeutic use
Prognosis
Recurrence
Registries
Retrospective Studies
Survival Analysis
Transplantation Conditioning - methods
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome
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Summary:Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2004-01-0231