Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation

Timothy S. Fenske, Kwang W. Ahn, Tara M. Graff, Alyssa DiGilio, Qaiser Bashir, Rammurti T. Kamble, Ernesto Ayala, Ulrike Bacher, Jonathan E. Brammer, Mitchell Cairo, Andy Chen, Yi Bin Chen, Saurabh Chhabra, Anita D'Souza, Umar Farooq, Cesar Freytes, Siddhartha Ganguly, Mark Hertzberg, David Inwards, Samantha JaglowskiMohamed A. Kharfan-Dabaja, Hillard M. Lazarus, Sunita Nathan, Attaphol Pawarode, Miguel Angel Perales, Nishitha Reddy, Sachiko Seo, Anna Sureda, Sonali M. Smith, Mehdi Hamadani

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

For diffuse large B-cell lymphoma (DLBCL) patients progressing after autologous haematopoietic cell transplantation (autoHCT), allogeneic HCT (alloHCT) is often considered, although limited information is available to guide patient selection. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 503 patients who underwent alloHCT after disease progression/relapse following a prior autoHCT. The 3-year probabilities of non-relapse mortality, progression/relapse, progression-free survival (PFS) and overall survival (OS) were 30, 38, 31 and 37% respectively. Factors associated with inferior PFS on multivariate analysis included Karnofsky performance status (KPS) <80, chemoresistance, autoHCT to alloHCT interval <1-year and myeloablative conditioning. Factors associated with worse OS on multivariate analysis included KPS<80, chemoresistance and myeloablative conditioning. Three adverse prognostic factors were used to construct a prognostic model for PFS, including KPS<80 (4 points), autoHCT to alloHCT interval <1-year (2 points) and chemoresistant disease at alloHCT (5 points). This CIBMTR prognostic model classified patients into four groups: low-risk (0 points), intermediate-risk (2-5 points), high-risk (6-9 points) or very high-risk (11 points), predicting 3-year PFS of 40, 32, 11 and 6%, respectively, with 3-year OS probabilities of 43, 39, 19 and 11% respectively. In conclusion, the CIBMTR prognostic model identifies a subgroup of DLBCL patients experiencing long-term survival with alloHCT after a failed prior autoHCT.

Original languageEnglish (US)
Pages (from-to)235-248
Number of pages14
JournalBritish Journal of Haematology
Volume174
Issue number2
DOIs
StatePublished - Jul 1 2016

Keywords

  • Allogeneic transplantation
  • DLBCL
  • Prior autologous transplan
  • Prognostic score

ASJC Scopus subject areas

  • Hematology

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    Fenske, T. S., Ahn, K. W., Graff, T. M., DiGilio, A., Bashir, Q., Kamble, R. T., Ayala, E., Bacher, U., Brammer, J. E., Cairo, M., Chen, A., Chen, Y. B., Chhabra, S., D'Souza, A., Farooq, U., Freytes, C., Ganguly, S., Hertzberg, M., Inwards, D., ... Hamadani, M. (2016). Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation. British Journal of Haematology, 174(2), 235-248. https://doi.org/10.1111/bjh.14046