Disease status but not histology is predictive of outcome in lymphoma patients after allogeneic stem cell transplantation with reduced-intensity conditioning regimen

Ref ID: 18631

Author:

L. Castagna (1), R. Bouabdallah (1), S. Fürst (1),
J. El Cheikh (1), C. Faucher (1), R. Crocchiolo (1), A. Granata (1),
J.M. Boher (1), M. Mohty (2), D. Blaise (1)

Author address:

(1)Institut Paoli Calmettes (Marseille, FR); (2)CHU Nantes
(Nantes, FR)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Background: Lymphoma patients with disease relapsed after
HDC or with disease refractory to several line of treatment can
be rescued with allogeneic stem cell transplantation. The aim
of this analysis was to report the results obtained in a cohort of
lymphoma patients treated with reduce intensity conditioning
regime (alloRIC) in a single institution.
Patients and methods: From 2001 and 2009, 113 lymphoma
patients received alloRIC. Main patient characteristics are
reported in the table Most patients received an association
of fludarabine (30 mg/m²/day, 5 days), oral or intravenous
busulphan (4 mg/kg or 3.2 mg/kg/day respectively, over
2 days), and thymoglobulin (2.5 mg/kg/day over 1 or 2 days).
For these patients, graft versus host disease prophylaxis
(GVHD) was cyclosporine (CyA) alone starting from days -3
at 3 mg/kg/day. Second most used conditioning consisted
of fludarabine (30 mg/m²/day for 3 days) and low dose total
body irradiation (TBI, 2 grays). For these patients, GVHD
prophylaxis consisted of CyA and mycophenolate mofetil
(MMF).
Results: After a median observation time of 28 months, the
3-year OS and PFS were 59% (CI 48%-68%) and 51% (CI
41%-61%), respectively. At last follow-up, 66 patients (58%)
were alive and 47 patients (42%) died. The treatment related
deaths were consequence of aGVHD 36% (11/30), cGVHD
23% (7/30), microbiologically not documented pneumonitis
10% (3/30), viral encephalitis 7% (2/30), graft failure 7% (2/30),
SNC haemorrhage 1, cerebral aspergillosis 1, neoplasia 2 pts.
One patient died of aGVHD after a second alloRIC for progressive disease. Univariate analysis showed that CR status at time
of alloRIC was signifi cantly associated to a better OS and PFS.
Histological subtype did not infl uence the OS.
aGVHD incidence was 43%, grade II-IV was 38% (65% grade
2, 18% grade 3, and 17% grade 4), and the median time of
diagnosis was 33 days (CI 11-114).
The cGVHD incidence was 33% (35/106), and the incidence
of extensive form was 71%. Cytomegalovirus infection was
detected in 13 patients (11%) at the median time of 34 days
(CI 1-83) after alloRIC. Only one gastro-intestinal CMV disease
was observed. The 100-day and 2-year TRM was 6% and 28%
(CI 20%-35%), respectively.
Conclusion: This retrospective analysis showed that, contrary
to other studies, histological subtype did not present a major
impact on outcome. Clinical results appear promising with a low
TRM and rather high outcome in a cohort of poor prognosis
lymphoma patients.

Abstract Number: P1064

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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