TY - JOUR
T1 - Histology and Time to Progression Predict Survival for Lymphoma Recurring after Reduced-Intensity Conditioning and Allogeneic Hematopoietic Cell Transplantation
AU - Ram, Ron
AU - Gooley, Ted A.
AU - Maloney, David G.
AU - Press, Oliver W.
AU - Pagel, John M.
AU - Petersdorf, Stephen H.
AU - Shustov, Andrei R.
AU - Flowers, Mary E.D.
AU - O'donnell, Paul
AU - Sandmaier, Brenda M.
AU - Storb, Rainer F.
AU - Gopal, Ajay K.
N1 - Funding Information:
Financial disclosure: Research funding was provided by the Leukemia and Lymphoma Society (SCOR Grant 7040 ), Lymphoma Research Foundation Mantle Cell Lymphoma Research Initiative, CLL Topics , the Mary A. Wright Memorial Research Fund , a donation from Frank and Betty Vandermeer, and NIH CA78902, CA18029, and CA15704. Ajay K. Gopal is a Scholar in Clinical Research of the Leukemia and Lymphoma Society. Ron Ram is a recipient of a fellowship award from the Davidoff Foundation. The authors have no conflicts of interest to disclose.
PY - 2011/10
Y1 - 2011/10
N2 - Reduced-intensity conditioning (RIC) before allogeneic hematopoietic cell transplantation (HCT) is increasingly used as a potentially curative option for patients with advanced lymphoma; however, relapse remains a major challenge. Unfortunately, little data are available on outcomes, predictors of survival, and results of specific management strategies in these patients. In the present study, a total of 101 consecutive relapses occurred and were evaluated in 280 patients with lymphoma who underwent RIC HCT. Diseases included aggressive non-Hodgkin lymphoma (NHL) (n = 42), indolent NHL (n = 33), and Hodgkin lymphoma (HL) (n = 26). Median time to relapse was 90 days (range, 3-1275 days), and graft-versus-host disease at relapse was present in 56 patients (55%). Interventions after relapse included no therapy (n = 14), withdrawal of immunosuppression alone (n = 11), chemoradiotherapy (n = 60), and donor lymphocyte infusion/second HCT (n = 16). Overall survival (OS) was 33% (95% confidence interval [CI], 23%-44%) at 3 years after relapse and 23% (95% CI, 13%-34%) at 5 years after relapse. Both aggressive NHL (vs indolent disease; hazard ratio, 2.29; P =.008) and relapse within 1 month post-HCT (vs >6 months; hazard ratio, 3.17; P =.004) were associated with increased mortality. Estimated 3-year OS was 16% (95% CI, 5%-32%) after relapse for aggressive NHL, 40% (95% CI, 19%-61%) after relapse for indolent NHL, and 47% (95% CI, 29%-64%) after relapse for HL. The 1-year survival was 24% for patients relapsing within 1 month post-HCT, compared with 52% for those relapsing at 1-3 months, 74% for those relapsing at 3-6 months, and 77% for those relapsing at more than 6 months. We conclude that despite relapse of lymphoma after RIC HCT, some patients may experience prolonged survival, with better postrelapse outcomes occurring in patients with indolent NHL, HL, or late relapse.
AB - Reduced-intensity conditioning (RIC) before allogeneic hematopoietic cell transplantation (HCT) is increasingly used as a potentially curative option for patients with advanced lymphoma; however, relapse remains a major challenge. Unfortunately, little data are available on outcomes, predictors of survival, and results of specific management strategies in these patients. In the present study, a total of 101 consecutive relapses occurred and were evaluated in 280 patients with lymphoma who underwent RIC HCT. Diseases included aggressive non-Hodgkin lymphoma (NHL) (n = 42), indolent NHL (n = 33), and Hodgkin lymphoma (HL) (n = 26). Median time to relapse was 90 days (range, 3-1275 days), and graft-versus-host disease at relapse was present in 56 patients (55%). Interventions after relapse included no therapy (n = 14), withdrawal of immunosuppression alone (n = 11), chemoradiotherapy (n = 60), and donor lymphocyte infusion/second HCT (n = 16). Overall survival (OS) was 33% (95% confidence interval [CI], 23%-44%) at 3 years after relapse and 23% (95% CI, 13%-34%) at 5 years after relapse. Both aggressive NHL (vs indolent disease; hazard ratio, 2.29; P =.008) and relapse within 1 month post-HCT (vs >6 months; hazard ratio, 3.17; P =.004) were associated with increased mortality. Estimated 3-year OS was 16% (95% CI, 5%-32%) after relapse for aggressive NHL, 40% (95% CI, 19%-61%) after relapse for indolent NHL, and 47% (95% CI, 29%-64%) after relapse for HL. The 1-year survival was 24% for patients relapsing within 1 month post-HCT, compared with 52% for those relapsing at 1-3 months, 74% for those relapsing at 3-6 months, and 77% for those relapsing at more than 6 months. We conclude that despite relapse of lymphoma after RIC HCT, some patients may experience prolonged survival, with better postrelapse outcomes occurring in patients with indolent NHL, HL, or late relapse.
KW - Donor lymphocyte infusion
KW - Graft-versus-lymphoma
KW - Lymphoproliferative diseases
UR - http://www.scopus.com/inward/record.url?scp=80052969289&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2011.03.010
DO - 10.1016/j.bbmt.2011.03.010
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C2 - 21536145
AN - SCOPUS:80052969289
SN - 1083-8791
VL - 17
SP - 1537
EP - 1545
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 10
ER -
