Allogeneic hematopoietic stem cell transplantation in patients with diffuse large B cell lymphoma relapsed after autologous stem cell transplantation: A GITMO study

Abstract

When citing, please refer to the published version.Link to this full text: http://hdl.handle.net/ Allogeneic hematopoietic stem cell transplantation in patients with diffuse large B cell lymphoma relapsed after autologous stem cell transplantation: A GITMO study AbstractPatients who relapse after an autologous hematopoietic stem cell transplantation (SCT) have a very poor prognosis. We have retrospectively analyzed diffuse large B cell lymphoma patients who underwent an allo-SCT after an auto-SCT relapse reported in the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) database. From 1995 to 2008, 3449 autologous transplants were reported in the GITMO database. Eight hundred eighty-four patients relapsed or progressed after transplant; 165 patients, 19% of the relapsed patients, were treated with allo-transplant. The stem cell donor was related to the patient in 108 cases. A reduced intensity conditioning regimen was used in 116. After allo-SCT, 72 patients (43%) obtained a complete response and 9 obtained a partial response with an overall response rate of 49%; 84 patients (51%) experienced rapid progression of disease. Ninety-one patients died, 45 due to disease and 46 due to treatment-related mortality. Acute graftversus-host disease was recorded in 57 patients and a chronic GvHD in 38 patients. With a median follow-up of 24 months (2-144) after allo, overall survival (OS) was 39%, and after a median of 21 months (2-138) after allo, progression-free survival (PFS) was 32%. Multivariate analysis indicated that the only factors affecting OS were status at allo-SCT, and those affecting PFS were status at allo-SCT and stem cell donor. This retrospective analysis shows that about one-fifth of patients with diffuse large B cell lymphoma who experience relapse after autologous transplantation may be treated with allogeneic transplantation. Moreover, the only parameter affecting either OS or PFS was the response status at the time of allo-SCT. KeywordsDiffuse large B cell lymphomaSalvage therapyAutologous stem cell transplantationAllogeneic stem cell transplantationReduced intensity conditioning regimenGraft versus lymphoma

Fludarabine and treosulfan compared with other reduced-intensity conditioning regimens for allogeneic stem cell transplantation in patients with lymphoid malignancies

“…23,24 NRM is lower after RIC, in the range of 20-35%, which is still higher than NRM after RIC in AML/myelodysplastic syndromes. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] This is possibly related to patients with lymphoma been older and more heavily treated at the time of SCT including a high incidence of prior autologous SCT. In the current study NRM was relatively low after FT and FB2, both 24%, similar to RIC regimens, whereas it was 54% after FM which is more similar to MAC regimens.…”

“…Survival rates in the range of 20-52% have been reported in other, smaller studies depending on patient characteristics at SCT. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Chemo-refractory disease is the most important predicting factor for survival across all studies. However, a small subset of patients with refractory lymphoma can achieve long-term survival with allogeneic SCT with both MAC and RIC.…”

“…41,42 Recent reports show that allogeneic SCT can induce long-term survival in 40-50% of patients. [23][24] The prognosis of patients with Hodgkin's lymphoma who relapse after autologous SCT is also poor. MAC was historically associated with very high NRM but about 15-20% were cured.…”

“…Most studies have shown increased relapse rates after RIC/NMA compared with MAC, resulting in similar survival. [20][21][22][23][24][25][26] Novel conditioning regimens which will preserve the disease control effect of MAC but will be associated with acceptable patterns of toxicity and maintain the graft-versus lymphoma effect, will be of benefit.…”

Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how?

“…Allo-HCT can be a curative therapy, for patients with relapsed or refractory DLBCL following auto-HCT and even in some cases for those with chemorefractory disease. [1][2][3][4][5][6][7][8] Unfortunately, many patients who relapse or progress after auto-HCT never achieve sufficient disease control to become a suitable candidate for allo-HCT. In addition, non-relapse mortality (NRM) remains problematic for allo-HCT in this setting.…”