Impact of Pretransplantation Conditioning Regimens on Outcomes of Allogeneic Transplantation for Chemotherapy-Unresponsive Diffuse Large B Cell Lymphoma and Grade III Follicular Lymphoma

被引：73

作者：

Hamadani, Mehdi ^{[1
]}

Saber, Wael ^{[2
]}

Ahn, Kwang Woo ^{[2
]}

Carreras, Jeanette ^{[2
]}

Cairo, Mitchell S. ^{[3
]}

Fenske, Timothy S. ^{[4
]}

Gale, Robert Peter ^{[5
]}

Gibson, John ^{[6
]}

Hale, Gregory A. ^{[7
]}

Hari, Parameswaran N. ^{[2
]}

Hsu, Jack W. ^{[8
,9
]}

Inwards, David J. ^{[10
]}

Kamble, Rammurti T. ^{[11
]}

Klein, Anderas ^{[12
]}

Maharaj, Dipnarine ^{[13
]}

Marks, David I. ^{[14
]}

Rizzieri, David A. ^{[15
]}

Savani, Bipin N. ^{[16
]}

Schouten, Harry C. ^{[17
]}

Waller, Edmund K. ^{[18
]}

Wirk, Baldeep ^{[8
,9
]}

Laport, Ginna. G. ^{[19
]}

Montoto, Silvia ^{[20
]}

Maloney, David G. ^{[21
]}

Lazarus, Hillard M. ^{[22
]}

机构：

[1] West Virginia Univ Hosp, Myeloma & Lymphoma Serv, Morgantown, WV USA

[2] Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA

[3] New York Presbyterian Hosp Cornell, New York, NY USA

[4] Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, Milwaukee, WI 53226 USA

[5] Univ London Imperial Coll Sci Technol & Med, London, England

[6] Royal Prince Alfred Hosp, Inst Haematol, Camperdown, NSW 2050, Australia

[7] Univ S Florida, All Childrens Hosp, St Petersburg, FL 33701 USA

[8] Shands Healthcare, Gainesville, FL USA

[9] Univ Florida, Gainesville, FL USA

[10] Mayo Clin, Rochester, MN USA

[11] Baylor Coll Med, Ctr Cell & Gene Therapy, Houston, TX 77030 USA

[12] Tufts Med Ctr, Boston, MA USA

[13] Bethesda Hlth City, Boynton Beach, FL USA

[14] Bristol Childrens Hosp, Bristol, Avon, England

[15] Duke Univ, Med Ctr, Durham, NC USA

[16] Vanderbilt Univ, Med Ctr, Brentwood, TN USA

[17] Acad Ziekenhuis Maastricht, Maastricht, Netherlands

[18] Emory Univ Hosp, Atlanta, GA 30322 USA

[19] Stanford Hosp & Clin, Stanford, CA USA

[20] Royal London Hosp Whitechapel, London, England

[21] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA

[22] Univ Hosp Cleveland, Case Med Ctr, Cleveland, OH 44106 USA

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2013年 / 19卷 / 05期

关键词：

DLBCL; Grade III follicular lymphoma; Allogeneic transplantation; Refractory; Relapsed; Graft-versus-host disease; NON-HODGKINS-LYMPHOMA; BONE-MARROW-TRANSPLANTATION; LONG-TERM OUTCOMES; REDUCED-INTENSITY; AUTOLOGOUS TRANSPLANTATION; RITUXIMAB; TIUXETAN; BLOOD; FLUDARABINE; EXPERIENCE;

D O I：

10.1016/j.bbmt.2013.01.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Patients with chemorefractory non-Hodgkin lymphomas generally have a poor prognosis. We used the observational database of the Center for International Blood and Marrow Transplant Research to study the outcome of 533 patients with refractory diffuse large B cell lymphoma (DLBCL) or grade III follicular lymphoma (FL-III) who underwent allogeneic hematopoietic cell transplantation (allo-HCT) using either myeloablative (MA; n = 307) or reduced-intensity/nonmyeloablative conditioning (RIC/NST; n = 226) between 1998 and 2010. We analyzed nonrelapse mortality (NRM), relapse/progression, progression-free survival (PFS); and overall survival (OS). Only 45% of the patients at transplantation had a Karnofsky performance score of >= 90%. Median follow-up of surviving patients after MA and RIC/NST allo-HCT is 35 months and 30 months, respectively. At 3 years, MA allo-HCT was associated with a higher NRM compared with RIC/NST (53% versus 42%; P = .03), similar PFS (19% versus 23%; P = .40), and lower OS (19% versus 28%; P = .02), respectively. On multivariate analysis, FL-III histology was associated with lower NRM (relative risk [RR], .52), reduced risk of relapse/progression (RR, .42), and superior PFS (RR, .51) and OS (RR, .53), whereas MA conditioning was associated with reduced risk of relapse/progression (RR, .66). Despite a refractory state, a small subset of DLBCL and FL-III patients can attain durable remissions after allo-HCT. Conditioning regimen intensity was not associated. with PFS and OS despite a higher risk of relapse/progression with RIC/NST allo-HCT. (C) 2013 American Society for Blood and Marrow Transplantation.

引用

页码：746 / 753

页数：8

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