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 Blood, 1 December 2004, Vol. 104, No. 12, pp. 3797-3803.
Prepublished online as a Blood First Edition Paper on July 27, 2004; DOI 10.1182/blood-2004-01-0231.

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TRANSPLANTATION

Myeloablative allogeneic hematopoietic stem cell transplantation in patients who experience relapse after autologous stem cell transplantation for lymphoma: a report of the International Bone Marrow Transplant Registry

César O. Freytes, Fausto R. Loberiza, J. Douglas Rizzo, Asad Bashey, Christopher N. Bredeson, Mitchell S. Cairo, Robert Peter Gale, Mary M. Horowitz, Thomas R. Klumpp, Rodrigo Martino, Philip L. McCarthy, Arturo Molina, Santiago Pavlovsky, Andrew L. Pecora, Derek S. Serna, Tsuong Tsai, Mei-Jie Zhang, Julie M. Vose, Hillard M. Lazarus, and Koen van Besien

From the Lymphoma Working Committee of the International Bone Marrow Transplant Registry (IBMTR); Health Policy Institute, Medical College of Wisconsin, Milwaukee; University of Texas Health Science Center, San Antonio; University of California at San Diego; Columbia University, New York, NY; Center for Advanced Studies in Leukemia, Los Angeles, CA; University of Pennsylvania, Philadelphia; Hospital Sant Creu I Sant Pau, Barcelona, Spain; Roswell Park Cancer Institute, Buffalo, NY; City of Hope National Medical Center, Duarte, CA; Fundaleu/"Angelica Ocampo," Buenos Aires, Argentina; Hackensack University Medical Plaza, NJ; University of Nebraska Medical Center, Omaha; Case Western Reserve University Hospital, Cleveland, OH; and University of Chicago, IL.

Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.


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