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

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)

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.
2011

abstract No: 

P1064

Full conference title: 

Annual Meeting of the EBMT, 37th
    • EBMT 37th (2011)