TY - JOUR
T1 - Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation
AU - Epperla, Narendranath
AU - Hamadani, Mehdi
AU - Ahn, Kwang W.
AU - He, Fiona
AU - Kodali, Dheeraj
AU - Kleman, Ariel
AU - Hari, Parameswaran N.
AU - Pasquini, Marcelo
AU - Fenske, Timothy S.
AU - Craig, Michael D.
AU - Kanate, Abraham S.
AU - Bachanova, Veronika
N1 - Publisher Copyright:
© 2018 The American Society for Blood and Marrow Transplantation
PY - 2018/5
Y1 - 2018/5
N2 - Outcome and management of patients who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) has evolved in the recent decade. Using a multi-institutional retrospective database we report the predictive factors and survival of lymphoma patients who relapse after allo-HCT. We evaluated 495 allo-HCT recipients transplanted between 2000 and 2015 at 3 academic US medical centers. Landmark analysis evaluating predictive factors was performed at 1 month after allo-HCT relapse with a primary endpoint of postrelapse overall survival (PR-OS). A total of 175 lymphoma patients (35%) experienced relapse after allo-HCT. Of these, 126 patients, median age 46 years (range, 19 to 71), were assessable. Most patients (86%) received subsequent therapy; 80 patients received targeted agents and 19 donor lymphocyte infusion. On univariate analysis median PR-OS for patients with Hodgkin lymphoma was 47.9 months compared with 11.3 months in patients with indolent and 10.1 months in aggressive non-Hodgkin lymphoma (P =.04). On multivariate analysis postrelapse therapy administration (no therapy versus targeted therapy: hazard ratio,.21 [95% confidence interval,.10 to.45]; no therapy versus nontargeted therapy: hazard ratio,.26 [95% confidence interval,.11 to.57]), late relapse 130 days after allo-HCT (relative to early relapse: hazard ratio,.25; P <.001), and Eastern Cooperative Oncology Group performance status of 0 to 1 (versus Eastern Cooperative Oncology Group performance status ≥ 2: hazard ratio,.49; P =.003) were associated with a significantly reduced risk of mortality. Patients relapsing ≥ 130 days from the time of allo-HCT yielded PR-OS of 48.8 months compared with 6.5 months in patients with early relapse (P <.001). Our data suggest that in the modern era, therapies used for patients experiencing lymphoma relapse after allo-HCT can extend survival.
AB - Outcome and management of patients who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) has evolved in the recent decade. Using a multi-institutional retrospective database we report the predictive factors and survival of lymphoma patients who relapse after allo-HCT. We evaluated 495 allo-HCT recipients transplanted between 2000 and 2015 at 3 academic US medical centers. Landmark analysis evaluating predictive factors was performed at 1 month after allo-HCT relapse with a primary endpoint of postrelapse overall survival (PR-OS). A total of 175 lymphoma patients (35%) experienced relapse after allo-HCT. Of these, 126 patients, median age 46 years (range, 19 to 71), were assessable. Most patients (86%) received subsequent therapy; 80 patients received targeted agents and 19 donor lymphocyte infusion. On univariate analysis median PR-OS for patients with Hodgkin lymphoma was 47.9 months compared with 11.3 months in patients with indolent and 10.1 months in aggressive non-Hodgkin lymphoma (P =.04). On multivariate analysis postrelapse therapy administration (no therapy versus targeted therapy: hazard ratio,.21 [95% confidence interval,.10 to.45]; no therapy versus nontargeted therapy: hazard ratio,.26 [95% confidence interval,.11 to.57]), late relapse 130 days after allo-HCT (relative to early relapse: hazard ratio,.25; P <.001), and Eastern Cooperative Oncology Group performance status of 0 to 1 (versus Eastern Cooperative Oncology Group performance status ≥ 2: hazard ratio,.49; P =.003) were associated with a significantly reduced risk of mortality. Patients relapsing ≥ 130 days from the time of allo-HCT yielded PR-OS of 48.8 months compared with 6.5 months in patients with early relapse (P <.001). Our data suggest that in the modern era, therapies used for patients experiencing lymphoma relapse after allo-HCT can extend survival.
KW - Allo-HCT
KW - Allogeneic hematopoietic cell transplantation
KW - Lymphoma
KW - PR-OS
KW - Postrelapse survival
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U2 - 10.1016/j.bbmt.2018.01.015
DO - 10.1016/j.bbmt.2018.01.015
M3 - Article
C2 - 29410340
AN - SCOPUS:85042234569
SN - 1083-8791
VL - 24
SP - 983
EP - 988
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -