Citations 2
Autologous or Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chemotherapy-Sensitive Mantle-Cell Lymphoma: Analysis of Transplantation Timing and Modality
Fenske, Timothy S. , Zhang, Mei-Jie , Carreras, Jeanette, Ayala, Ernesto , Burns, Linda J. , Cashen, Amanda F. , Costa, Luciano J. , Freytes, César O. , Holmberg, Leona , Inwards, David J. , Munker, Reinhold , Rizzieri, David A. , Schouten, Harry C. , Smith, Sonali M. , Waller, Edmund K. , Wirk, Baldeep , Laport, Ginna G. , Maloney, David G. , Montoto, Silvia , Hari, Parameswaran , Holmberg, Leona , Zhang, Mei‐Jie , Gale, Robert Peter , Hamadani, Mehdi , Lazarus, Hillard M. , Maziarz, Richard Thomas , Perales, Miguel‐Angel , Waller, Edmund K , Montoto, Silvia , Costa, Luciano J , Hari, Parameswaran
Journal of Clinical Oncology | December 17, 2013 | Volume: 32 | Issue: 4 | Pages: 273-281
PurposeTo examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course.Patients and MethodsIn all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients.ResultsAuto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwent auto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT.ConclusionFor patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.
Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity?
Klyuchnikov, Evgeny , Carreras, Jeanette, Armand, Philippe , Bishop, Michael, Bredeson, Christopher , Cairo, Mitchell S. , Fenske, Timothy S. , Freytes, César O. , Gibson, John, Isola, Luis , Inwards, David J. , Laport, Ginna G. , Wiernik, Peter H. , Schouten, Harry C. , Slavin, Shimon, Smith, Sonali M. , Waller, Edmund K. , Hari, Parameswaran , Bacher, Ulrike , Le‐Rademacher, Jennifer , Gale, Robert Peter , Lazarus, Hillard M. , Maziarz, Richard Thomas , Vose, Julie M. , Waller, Edmund K , Hari, Parameswaran
Blood | September 25, 2012 | Volume: 120 | Issue: 20 | Pages: 4256-4262
Abstract The best conditioning regimen before allogeneic transplantation for high-risk diffuse large B-cell lymphoma (DLBCL) remains to be clarified. We analyzed data from 396 recipients of allotransplants for DLBCL receiving myeloablative (MAC; n = 165), reduced intensity (RIC; n = 143), or nonmyeloablative conditioning (NMAC; n = 88) regimens. Acute and chronic GVHD rates were similar across the groups. Five-year nonrelapse mortality (NRM) was higher in MAC than RIC and NMAC (56% vs 47% vs 36%; P = .007). Five-year relapse/progression was lower in MAC than in RIC/NMAC (26% vs 38% vs 40%; P = .031). Five-year progression-free survival (15%-25%) and overall survival (18%-26%) did not differ significantly between the cohorts. In multivariate analysis, NMAC and more recent transplant year were associated with lower NRM, whereas a lower Karnofsky performance score (< 90), prior relapse resistant to therapy, and use of unrelated donors were associated with higher NRM. NMAC transplants, no prior use of rituximab, and prior relapse resistant to therapy were associated with a greater risk of relapse/progression. In conclusion, allotransplantation with RIC or NMAC induces long-term progression-free survival in selected DLBCL patients with a lower risk of NRM but with higher risk of lymphoma progression or relapse.