Allogeneic Stem-Cell Transplantation for Relapsed Lymphoma

Patients with relapsed diffuse large B-cell lymphoma after autologous STC benefited from allogeneic STC.

Patients with diffuse large B-cell lymphoma (DLBCL) who relapse after salvage chemotherapy and autologous stem-cell transplantation (SCT) experience poor outcomes and, typically, short survival. Although allogeneic transplantation is a curative option for these patients, long-term data are limited.

Now, investigators have reviewed records from a European transplantation registry to assess outcomes of adult patients with relapsed DLBCL after prior autologous SCT. A total of 101 such patients underwent allogeneic SCT from 1997 to 2006. Of these, 37 (median age, 43) underwent myeloablative conditioning, and 64 (median age, 54) underwent reduced-intensity conditioning (RIC). Matched sibling donors were used for 72 patients; matched unrelated donors were used for 29 patients.

The progression-free survival (PFS) rate at 3 years for the entire cohort was 41.7%, and the overall survival (OS) rate was 53.8%. Nonrelapse mortality at 3 years was higher among patients who underwent myeloablative conditioning versus RIC (41% vs. 20%; P=0.05). Relapse rates were higher for patients who underwent RIC, for those who relapsed within the first year of autologous SCT, and for those who were chemotherapy resistant prior to allogeneic SCT. PFS and OS were unaffected by donor source.

Comment: Even though allogeneic SCT provides a potentially curative option for patients with relapsed DLBCL, clear challenges remain to lower the high rates of nonrelapse mortality as well as the high rates of transplant-related morbidity, given that long-term survivors often experience ongoing complications of graft-versus-host disease. Important unmet needs also exist for patients who experience early relapse after autologous SCT and for those with chemotherapy-refractory disease. Disappointingly, no clear graft-versus-lymphoma effect could be demonstrated in this study, except in patients with DLBCL arising from transformed follicular lymphoma. Ultimately, improved patient selection for allogeneic SCT coupled with more-effective second- and third-line treatment regimens is needed to continue the recent advances in curing DLBCL.

Source:Journal Watch Oncology and Hematology