Work

Myeloablative vs non-myeloablative conditioning with allogeneic stem cell transplantation for high risk non-Hodgkin’s lymphoma: Similar outcomes despite differences in disease risk

Year: 2005

Type: article

Abstract: For patients (pts) with Non-Hodgkin’s Lymphoma (NHL), the optimal timing and conditioning regimen intensity for transplant has not been defined. Nonmyeloablative stem cell transplants (NMT) have been reserved for those patients at high risk for treatment related morbidity and mortality (TRM) from conventional High Dose allogeneic SCT (HDT) and have been increasingly employed as salvage therapy for relapse after autotransplantation. To assess the effectiveness of this approach, we performed a retrospective analysis of 35 pts who have undergone either HDT (n=20) with a TBI-based regimen or NMT (n=15) with a fludarabine-based regimen followed by allogeneic SCT for high risk NHL. Stem cell source varied by conditioning; 13/15 of HDT pts received bone marrow (11 sib, 2 MUD), while all NMT pts received peripheral blood (11 sib, 9 MUD). NMT pts constituted a higher risk cohort based on extent of prior therapy (including 80% s/p autotransplant), chemoresistance, and age. Distribution of histology for the entire group was skewed toward aggressive histology, but equally distributed between HDT and NMT. For pts surviving >90 days, median follow up for HDT pts is 50 months (4–92 m), vs 12 months (4–45 m) for NMT pts. A comparison of overall survival (53 vs 45%), event-free survival (53 vs 48%), and progression-free survival (88 vs 64%) at 1 year demonstrated no significant differences between HDT and NMT cohorts despite the higher risk nature of the NMT group. The 100-day TRM for HDT vs NMT pts was similar (33 vs 30%, p=ns). The incidence of grade II-IV acute GvHD was not significantly different between HDT (3/13 evaluable, 23%) and NMT (7/20, 35%). Among evaluable pts, chronic GvHD was lower in the HDT group vs NMT (13 vs 50%). Among causes of death, disease-related deaths were lower in the HDT group (1/7, 14%) compared with NMT pts (5/11, 45%). This retrospective analysis demonstrates 1) NMT induces durable remissions in a significant number of poor risk pts; 2) outcomes after NMT may be comparable to HDT; 3) relapse rates are higher after NMT while TRM is higher after HDT; and 4) long term remissions suggest that NMT is associated with an important graft vs lymphoma effect.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2004.12.079