Citations 2
Autologous haematopoietic cell transplantation for non‐Hodgkin lymphoma with secondary CNS involvement
Wang, Zhiwei , Zhang, Mei‐Jie , Bolwell, Brian J., Chen, Andy I. , Fenske, Timothy S. , Freytes, César O. , Gibson, John, Hayes‐Lattin, Brandon , Holmberg, Leona , Inwards, David J. , Isola, Luis , Khoury, H. Jean , Lewis, Victor , Maharaj, Dipnarine , Munker, Reinhold , Phillips, Gordon L., Rizzieri, David A. , Rowlings, Philip A., Saber, Wael , Satwani, Prakash , Waller, Edmund K. , Maloney, David G. , Montoto, Silvia , Laport, Ginna G. , Hari, Parameswaran , Holmberg, Leona , Chen, Andy , Maziarz, Richard Thomas , Gale, Robert Peter , Vose, Julie M. , Lazarus, Hillard M. , Waller, Edmund K , Montoto, Silvia , Hari, Parameswaran
British Journal of Haematology | July 6, 2013 | Volume: 162 | Issue: 5 | Pages: 648-656
SummaryPre‐existing central nervous system (CNS) involvement may influence referral for autologous haematopoietic cell transplantation (AHCT) for patients with non‐Hodgkin lymphoma (NHL). The outcomes of 151 adult patients with NHL with prior secondary CNS involvement (CNS+) receiving an AHCT were compared to 4688 patients without prior CNS lymphoma (CNS−). There were significant baseline differences between the cohorts. CNS+ patients were more likely to be younger, have lower performance scores, higher age‐adjusted international prognostic index scores, more advanced disease stage at diagnosis, more aggressive histology, more sites of extranodal disease, and a shorter interval between diagnosis and AHCT. However, no statistically significant differences were identified between the two groups by analysis of progression‐free survival (PFS) and overall survival (OS) at 5 years. A matched pair comparison of the CNS+ group with a subset of CNS− patients matched on propensity score also showed no differences in outcomes. Patients with active CNS lymphoma at the time of AHCT (n = 55) had a higher relapse rate and diminished PFS and OS compared with patients whose CNS lymphoma was in remission (n = 96) at the time of AHCT. CNS+ patients can achieve excellent long‐term outcomes with AHCT. Active CNS lymphoma at transplant confers a worse prognosis.
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.