Citations 42
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.
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.