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171: Allogeneic Hematopoietic Stem Cell Transplantation has Curative Potential for Chemorefractory Non-Hodgkin Lymphoma

Year: 2008

Type: article

Abstract: Background: Autologous hematopoietic stem cell transplantation (auto-HSCT) has been widely used in patients with relapsed chemosensitive non-Hodgkin lymphoma (NHL), but the prognosis of patients with chemorefractory NHL remains poor. We compared our experience of allo-HSCT with auto-HSCT for patients with NHL. Methods: A total of 377 patients with NHL underwent allo-HSCT (n = 172, median age: 49 years old, range 18–71) or auto-HSCT (n = 205, median age: 56 years old, range 3–71) between 1996 and 2006 at University of Michigan. Patients who underwent allo-HSCT for relapse after auto-HSCT were excluded. Chemorefractory disease is defined as stable or progressive disease at transplantation. Results: NHL was classified as aggressive in 270 patients (168 diffuse large B-cell lymphoma, 58 mantle cell lymphoma, 44 peripheral T cell lymphoma), and as indolent in 107 patients (follicular lymphoma). In the allo-HSCT group (related donor: n = 122, unrelated donor: n = 50), 141 patients (median age: 47 years old, range 18–64) underwent full-intensity conditioning (FIC) and 31 (median age: 58 years old, range 44–71) reduced-intensity conditioning (RIC). Overall survival (OS) at 5-year in chemosensitive patients was 46.2% (95% CI, 33.1–59.3) in the allo-HSCT group (n = 63) and 41.0% (30.7–51.3) in the auto-HSCT group (n = 176). OS in chemorefractory patients was 35.0% (5-year OS, 25.2–44.8) with survival plateau in the allo-HSCT group (n = 109) but only 7.4% (4-year OS, 0–20.3) in the auto-HSCT group (n = 29). In multivariate analysis using a Cox hazard model for the entire cohort, chemorefractory disease (Hazard ratio [HR], 1.73; 95%CI, 1.25–2.39; p = 0.001) and age over 50 (HR, 1.57; 95%CI, 1.19–2.07; p = 0.001) were identified as significant risk factors on progression-free survival (PFS). In chemorefractory indolent NHL, patients with RIC had a better outcome than auto-HSCT (p = 0.016) or FIC (p = 0.083), with 5-year PFS of 56.1% (26.2–86.0) in RIC, 0% in auto-HSCT and 20.4% (2.6–38.2) in FIC. Conclusions: Allo-HSCT has curative potential for patients even in chemorefractory NHL. RIC for indolent NHL provided significant PFS for patients even with chemorefractory disease, and merits further investigation.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.180