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 Blood, 1 October 2007, Vol. 110, No. 7, pp. 2744-2748.
Prepublished online as a Blood First Edition Paper on June 26, 2007; DOI 10.1182/blood-2007-03-078592.

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TRANSPLANTATION

Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

Christoph Kahl1, Barry E. Storer1,2, Brenda M. Sandmaier1,2, Marco Mielcarek1,2, Michael B. Maris3, Karl G. Blume4, Dietger Niederwieser5, Thomas R. Chauncey1,2,6, Stephen J. Forman7, Edward Agura8, Jose F. Leis9, Benedetto Bruno10, Amelia Langston11, Michael A. Pulsipher12, Peter A. McSweeney3, James C. Wade13, Elliot Epner9, Finn Bo Petersen14, Wolfgang A. Bethge15, David G. Maloney1,2, and Rainer Storb1,2

1 Fred Hutchinson Cancer Research Center, Seattle, WA; 2 University of Washington, Seattle, WA; 3 Rocky Mountain Blood and Marrow Transplant Program, Denver, CO; 4 Stanford University, CA; 5 University of Leipzig, Leipzig, Germany; 6 Veterans Affairs Puget Sound Health System, Seattle, WA; 7 City of Hope National Medical Center, Duarte, CA; 8 Baylor University, Dallas, TX; 9 Oregon Health and Science University, Portland; 10 University of Torino, Torino, Italy; 11 Emory University, Atlanta, GA; 12 University of Utah Health Sciences Center, Salt Lake City; 13 Medical College of Wisconsin, Milwaukee; 14 Latter Day Saints (LDS) Hospital, Salt Lake City, UT; and 15 University Hospital Tübingen, Tübingen, Germany

Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for hematologic malignancies depends on graft-versus-tumor effects for eradication of cancer. Here, we estimated relapse risks according to disease characteristics. Between 1997 and 2006, 834 consecutive patients (median age, 55 years; range, 5-74 years) received related (n = 498) or unrelated (n = 336) HCT after 2 Gy total body irradiation alone (n = 171) or combined with fludarabine (90 mg/m2; n = 663). Relapse rates per patient year (PY) at risk, corrected for follow-up and competing nonrelapse mortality, were calculated for 29 different diseases and stages. The overall relapse rate per PY was 0.36. Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in remission (CR), low-grade or mantle cell non-Hodgkin lymphoma (NHL) (CR + partial remission [PR]), and high-grade NHL-CR had the lowest rates (0.00-0.24; low risk). In contrast, patients with advanced myeloid and lymphoid malignancies had rates of more than 0.52 (high risk). Patients with lymphoproliferative diseases not in CR (except Hodgkin lymphoma and high-grade NHL) and myeloid malignancies in CR had rates of 0.26-0.37 (standard risk). In conclusion, patients with low-grade lymphoproliferative disorders experienced the lowest relapse rates, whereas patients with advanced myeloid and lymphoid malignancies had high relapse rates after nonmyeloablative HCT. The latter might benefit from cytoreductive treatment before HCT.


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