Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Oncology, HIGH-DOSE THERAPY, CHEMOTHERAPY, DISEASE, EXPERIENCE, OUTCOMES, LEUKEMIA, FAILURE, REGIMEN, GRADE, Adolescent, Adult, Aged, Chi-Square Distribution, Disease-Free Survival, Europe, Female, Histocompatibility Testing, Humans, Kaplan-Meier Estimate, Lymphoma, Large B-Cell, Diffuse, Male, Middle Aged, Myeloablative Agonists, Recurrence, Registries, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Salvage Therapy, Stem Cell Transplantation, Survival Rate, Time Factors, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Homologous, Treatment Failure, Young Adult, 1103 Clinical Sciences, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, 3211 Oncology and carcinogenesis

Abstract:

PURPOSE: To analyze the outcome, including nonrelapse mortality (NRM), relapse rate (RR), progression-free survival (PFS), and overall survival (OS), of patients with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) relapsed after an autologous stem-cell transplantation (ASCT) and treated with an allogeneic stem-cell transplantation (allo-SCT). PATIENTS AND METHODS: The European Group for Blood and Marrow Transplantation database was scanned for a first allo-SCT in relapsed DLBCL after a previous ASCT between 1997 and 2006. Other inclusion criteria were age at allo-SCT ≥ 18 years and availability of an HLA-identical sibling or a matched unrelated donor. A total of 101 patients (57 males; median age, 46 years) were included. Median follow-up for survivors was 36 months. RESULTS: Myeloablative conditioning regimen was used in 37 patients and reduced intensity conditioning (RIC) was used in 64 patients. Three-year NRM was 28.2% (95% CI, 20% to 39%), RR was 30.1% (95% CI, 22% to 41%), PFS was 41.7% (95% CI, 32% to 52%), and OS was 53.8% (95% CI, 44% to 64%). NRM was significantly increased in patients ≥ 45 years (P = .01) and in those with an early relapse (< 12 months) after ASCT (P = .01). RR was significantly higher in refractory patients (P = .03). A time interval to relapse after ASCT of < 12 months was associated with lower PFS (P = .03). The use of RIC regimens was followed by a trend to a lower NRM (P = .1) and a trend to a higher RR (P = .1), with no differences in PFS and OS. No differences were seen between HLA-identical siblings and matched unrelated donors. CONCLUSION: Allo-SCT in relapsed DLBCL after ASCT is a promising therapeutic modality. Patients with a long remission after ASCT and with sensitive disease at allo-SCT are the best candidates for this approach.