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Blood, Vol. 92 No. 5 (September 1), 1998:
pp. 1832-1836
Allogeneic Bone Marrow Transplantation for Low-Grade Lymphoma
Koen van Besien,
Kathleen A. Sobocinski,
Philip A. Rowlings,
Sandra C. Murphy,
James O. Armitage,
Michael R. Bishop,
Ok-kyong Chaekal,
Robert Peter Gale,
John P. Klein,
Hillard M. Lazarus,
Philip
L. McCarthy Jr,
John M.M. Raemaekers,
Josy Reiffers,
Gordon L. Phillips,
Anton V.M.B. Schattenberg,
Leo F. Verdonck,
Julie M. Vose, and
Mary M. Horowitz
From the Joint Lymphoma Working Committee of the International Bone
Marrow Transplant Registry and the Autologous Blood and Marrow
Transplant Registry, Health Policy Institute, Medical College of
Wisconsin, Milwaukee; the Section of Hematology/Oncology, University of
Illinois, Chicago; the Department of Internal Medicine, University of
Nebraska Medical Center, Omaha; the Division of Bone Marrow and Stem
Cell Transplantation, Salick Health Care, Inc, Los Angeles, CA; the
Department of Medicine, Ireland Cancer Center, University Hospitals of
Cleveland, Case Western Reserve University, Cleveland, OH; the
Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; the
Division of Hematology, University Hospital St Radboud, Nijmegen, The
Netherlands; Unite de Greffe, Hospital Haut-Leveque, Pessac, France;
Division of Bone Marrow Transplantation, Markey Cancer Center,
University of Kentucky, Lexington, KY; and the Haematology Department,
University Hospital Utrecht, Utrecht, The Netherlands.
Advanced low-grade lymphomas are usually incurable with
conventional-dose chemotherapy. It is uncertain whether
cures are possible with high-dose therapy and bone marrow transplant
from a human leukocyte antigen (HLA)-identical sibling. We sought to determine the outcome of HLA-identical sibling bone marrow transplants in advanced low-grade lymphoma in an observational study of 113 patients conducted at 50 centers participating in the International Bone Marrow Transplant Registry (IBMTR). The median patient age was 38 years (range, 15 to 61). Eighty percent had stage IV disease at the
time of transplantation. The median number of prior chemotherapy regimens was two (range, 0 to 5). Thirty-eight percent had refractory disease and 29% a Karnofsky performance score (KPS) less than 80%.
All patients underwent allogeneic bone marrow transplantation from a
HLA-identical sibling donor. The conditioning regimen included total-body irradiation (TBI) in 82% of patients; cyclosporine was used
for graft-versus-host disease prophylaxis in 74%. Survival, disease-free survival, recurrence rate, treatment-related mortality, and causes of death were determined. Three-year probabilities of
recurrence, survival, and disease-free survival were 16% (95% confidence interval [CI], 9% to 27%), 49% (95% CI, 39% to 60%), and 49% (95% CI, 39% to 59%), respectively. Higher survival was associated with pretransplant KPS  90%, chemotherapy-sensitive disease, use of a TBI-containing conditioning regimen, and age less
than 40 years. We conclude that high-dose therapy followed by
transplantation from a HLA-identical sibling leads to prolonged survival in some patients with advanced low-grade lymphoma. Most mortality is treatment-related, and recurrences are rare.
© 1998 by The American Society of Hematology.
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