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Prepublished online as a Blood First Edition Paper on August 15, 2002; DOI 10.1182/blood-2001-11-0107.
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Blood, 15 December 2002, Vol. 100, No. 13, pp. 4310-4316
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Chemoresistant or aggressive lymphoma predicts for a poor
outcome following reduced-intensity allogeneic progenitor cell
transplantation: an analysis from the Lymphoma Working Party of the
European Group for Blood and Bone Marrow Transplantation
Stephen P. Robinson,
Anthony H. Goldstone,
Stephen Mackinnon,
Angelo Carella,
Nigel Russell,
Carmen Ruiz de
Elvira,
Goli Taghipour, and
Norbert Schmitz
From the Lymphoma Working Party of the European Group
for Blood and Bone Marrow Transplantation (see appendix for
contributing centers).
We report the outcome of reduced-intensity allogeneic progenitor
cell transplantation (alloPCT) for 188 patients with lymphoma from the Working Party Lymphoma of the European Group for Blood and
Bone Marrow Transplantation (EBMT). The median age of the patients was
40 years, the median number of prior treatment courses was 3, and 48%
of patients had undergone a prior autologous transplantation. Eighty-four percent of the patients received conditioning with fludarabine-based regimens and 10% with the BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) protocol. Full donor chimerism was confirmed in 71% of 100 patients assessed. Acute graft-versus-host disease (GVHD) developed in 37% of patients and chronic GVHD in 17%.
A disease response to donor leukocyte infusion (DLI) was seen in 10 of
14 patients. With a median follow-up of 283 days, the overall survival
rates at 1 and 2 years were 62% and 50%, respectively. The 100-day
and 1-year transplantation-related mortality (TRM) rates were
12.8% and 25.5%, respectively, and were significantly worse for older
patients. The probability of disease progression at 1 year for patients
with chemoresistant and chemosensitive disease were 75% and 25%,
respectively (P = .001). The progression-free survival at
1 year was 46% and was significantly better for those with
chemosensitive disease, Hodgkin disease (HD), and low-grade non-Hodgkin
lymphoma (NHL). Patients with high-grade NHL, mantle cell lymphoma, or
chemoresistant disease had a poor outcome. Reduced-intensity progenitor
cell transplantation is associated with a reduced TRM and may control
advanced HD and low-grade NHL. A longer period of follow-up is required
to determine the benefit of DLI and the graft-versus-lymphoma effect.

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