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Allogeneic bone marrow transplantation for low-grade lymphoma
K van Besien1, K A Sobocinski, P A Rowlings
1Joint Lymphoma Working Committee of the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA.
Blood
|August 26, 1998
Summary
High-dose therapy with human leukocyte antigen (HLA)-identical sibling bone marrow transplants can prolong survival for advanced low-grade lymphoma patients. While recurrences are rare, treatment-related mortality remains a concern.
Area of Science:
- Hematology
- Oncology
- Transplant Immunology
Background:
- Advanced low-grade lymphomas are often incurable with standard chemotherapy.
- The efficacy of high-dose therapy and allogeneic bone marrow transplantation (BMT) for these lymphomas remains uncertain.
Purpose of the Study:
- To evaluate the outcomes of HLA-identical sibling BMT in patients with advanced low-grade lymphoma.
- To determine survival rates, disease recurrence, and treatment-related mortality.
Main Methods:
- An observational study of 113 patients with advanced low-grade lymphoma undergoing HLA-identical sibling BMT.
- Data collected from 50 centers participating in the International Bone Marrow Transplant Registry (IBMTR).
- Analysis included conditioning regimens (82% with total-body irradiation), graft-versus-host disease prophylaxis, and patient characteristics (median age 38, 80% stage IV, median 2 prior regimens).
Main Results:
- Three-year probabilities for recurrence, survival, and disease-free survival were 16%, 49%, and 49%, respectively.
- Higher survival rates were associated with pretransplant Karnofsky Performance Score (KPS) ≥90%, chemotherapy-sensitive disease, total-body irradiation-containing regimens, and age <40 years.
- Most mortality was treatment-related, with rare recurrences.
Conclusions:
- High-dose therapy followed by HLA-identical sibling BMT can achieve prolonged survival in select patients with advanced low-grade lymphoma.
- Treatment-related mortality is a significant factor, and recurrence rates are low.
- Further research may focus on optimizing conditioning regimens and supportive care to reduce treatment-related mortality.