Hematopoietic stem cell transplantation in malignant lymphoproliferative diseases. A single center, retrospective...

During the 1982-1997 period, out of the 133 hematopoietic stem cell (HSC) transplantations performed at Mont Godinne for malignant hemopathies, 85 were done in lymphoproliferative diseases: 27 in aggressive non-Hodgkin's lymphomas (ANHL), 21 in multiple myeloma (MM) patients, 17 in low-grade non-Hodgkin's lymphomas (LNHL), 9 in Hodgkin's disease (HD) cases, 9 in acute lymphoblastic leukemia (ALL) and 2 in chronic lymphocytic leukemia (CLL) patients. According to the HSC source, there were 19 allogeneic bone marrow grafts and 66 autologous HSC grafts (14 bone marrow and 52 peripheral stem cell grafts). In 40 cases the procedure was done after achieving partial or complete remission through conventional chemotherapy and in 45 patients in case of relapse or progressive disease. The conditioning regimens consisted of high-dose chemotherapy, associated with total body irradiation in case of allografts and in autografts for ALL. Engraftment was obtained in all autografted patients, transplant related mortality (TRM) occurring in 2 patients (3%). In the allogeneic transplantation group, 1 patient did not engraft and TRM was much higher, occurring in 10 cases (52%). Hematologic recovery occurred significantly faster in the autograft group than in the allograft group. The overall costs of an autograft were much lower than those of an allograft. Out of the 59 patients followed 4 years or longer, 23 (39%) are alive, free of disease, the proportion varying from 57% in the HD cases to 16% in the MM cases. The overall survival at 4 years was 49%. Negative prognostic factors for disease free survival at 4 years included male sex, lack of complete remission status at transplantation and MM diagnosis, whereas male sex and allografting were the negative prognostic factors for the 4-year overall survival.