Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity?

Ulrike Bacher*, Evgeny Klyuchnikov, Jennifer Le-Rademacher, Jeanette Carreras, Philippe Armand, Michael R. Bishop, Christopher N. Bredeson, Mitchell S. Cairo, Timothy S. Fenske, Cesar O. Freytes, Robert Peter Gale, John Gibson, Luis M. Isola, David J. Inwards, Ginna G. Laport, Hillard M. Lazarus, Richard T. Maziarz, Peter H. Wiernik, Harry C. Schouten, Shimon SlavinSonali M. Smith, Julie M. Vose, Edmund K. Waller, Parameswaran N. Hari

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

85 Citations (Web of Science)

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.
Original languageEnglish
Pages (from-to)4256-4262
JournalBlood
Volume120
Issue number20
DOIs
Publication statusPublished - 15 Nov 2012

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