Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan

Abstract

Summary:We conducted a nation-wide survey of 112 adult Japanese patients who underwent reduced-intensity stem cell transplantation (RIST) from 1999 to 2002. Underlying diseases included indolent (n ¼ 45), aggressive (n ¼ 58) and highly aggressive lymphomas (n ¼ 9). Median age of the patients was 49 years. A total of 40 patients (36%) had relapsed diseases after autologous stem cell transplantation and 36 patients (32%) had received radiotherapy. RIST regimens were fludarabine-based (n ¼ 95), low-dose total body irradiation-based (n ¼ 6) and others (n ¼ 11). Cumulative incidences of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were, respectively, 49 and 59%. Cumulative incidences of progression and progression-free mortality were 18 and 25%, respectively. With a median follow-up of 23.9 months, 3-year overall survival rates were 59%. A multivariate analysis identified three significant factors for progression, which are history of radiation (relative risk (RR) 3.45, confidential interval (CI) 1.12-10.0, P ¼ 0.03), central nervous system involvement (RR 6.25, CI 2.08-20.0, P ¼ 0.001) and development of GVHD (RR 0.28, CI 0.090-0.86, P ¼ 0.026). RIST may have decreased the rate of transplant-related mortality, and GVHD may have induced a graft-versuslymphoma effect. However, whether or not these potential benefits can be directly translated into improved patient survival should be evaluated in further studies. Keywords: graft-versus-host disease; graft-versus-lymphoma effect; nonmyeloablative hematopoietic stem cell transplantation; indolent lymphoma; aggressive lymphoma Allogeneic stem cell transplantation (allo-SCT) is a curative treatment for advanced malignant lymphoma. 1,2 Initially, the benefit of allo-SCT was thought to be largely dependent on the intensity of the conditioning regimen prior to transplantation. Recently, an additional benefit of allo-SCT is derived from an allogeneic graft-versus-malignancy (GVM) effect that reduces the likelihood of disease relapse following transplantation. [3][4][5][6] With high regimen-related toxicity (RRT) and treatment-related mortality (TRM), high-intensity, myeloablative conditioning regimens are being replaced by reduced-intensity or nonmyeloablative conditioning regimens. The preliminary data suggest improved survival rates due to decreased TRM. 7 Reduced-intensity stem cell transplantation (RIST) is potentially a curative treatment for heavily pretreated, elderly patients; however, little information is available regarding the outcomes of RIST for malignant lymphoma. We retrospectively analyzed the outcome of RIST. The purpose of this study was to elucidate the treatment-related toxicity of RIST and to evaluate the impact of a potential graftversus-lymphoma (GVL) effect. Patients and methods Data collectionWe conducted a nation-wide retrospective survey of 112 adult Japanese patients who underwent RIST from 1999 to 2002 in 32 participating hospitals. All of the RIST recipients who were eligible in this study were included in each hospital. In...

Allogeneic transplantation in lymphoma: current status

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Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

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Increased intensity of acute graft-versus-host disease after reduced-intensity bone marrow transplantation compared to conventional transplantation from an HLA-matched sibling in children

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