Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation

Frédéric Baron, Rainer Storb, Barry E. Storer, Michael B. Maris, Dietger Niederwieser, Judith A. Shizuru, Thomas R. Chauncey, Benedetto Bruno, Stephen J. Forman, Peter A. McSweeney, Richard Maziarz, Michael A. Pulsipher, Edward D. Agura, James Wade, Mohamed Sorror, David G. Maloney, Brenda M. Sandmaier

Research output: Contribution to journalArticle

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Abstract

Purpose: Several studies have investigated the feasibility of allogeneic hematopoietic cell transplantations (HCTs) after reduced-intensity conditioning in patients who experienced relapse after myeloablative HCT. Although most studies showed relatively low nonrelapse mortality (NRM) rates and encouraging short-term results, it has yet to be defined which patients would benefit most from these approaches. Patients and Methods: We analyzed data from 147 patients with hematologic malignancies who experienced treatment failure with conventional autologous (n = 135), allogeneic (n = 10), or syngeneic (n = 2) HCT and were treated with HLA-matched related (n = 62) or unrelated (n = 85) grafts after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Results: Three-year probabilities of NRM, relapse, and overall survival were 32%, 48%, and 27%, respectively, for related recipients, and 28%, 44%, and 44%, respectively, for unrelated recipients. The best outcomes were observed in patients with non-Hodgkin's lymphoma, whereas patients with multiple myeloma and Hodgkin's disease had worse outcomes as a result of high incidences of relapse and progression. Being in partial remission (PR) or complete remission (CR) at HCT (P = .002) and developing chronic graft-versus-host disease (GVHD; P = .03) resulted in lower risks of relapse and progression. Factors associated with better overall survival were PR or CR (P = .01) and lack of comorbidity (P = .03) at HCT and absence of acute GVHD after HCT (P = .06). Conclusion: Encouraging outcomes were seen with allogeneic HCT after nonmyeloablative conditioning in selected patients who had experienced relapse after a high-dose HCT, particularly in patients with non-Hodgkin's lymphoma. Results with unrelated grafts were comparable with results with related grafts.

Original languageEnglish (US)
Pages (from-to)4150-4157
Number of pages8
JournalJournal of Clinical Oncology
Volume24
Issue number25
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Cell Transplantation
Recurrence
Transplants
Non-Hodgkin's Lymphoma
Survival
Mortality
Whole-Body Irradiation
Graft vs Host Disease
Hematologic Neoplasms
Treatment Failure
Multiple Myeloma
Hodgkin Disease
Comorbidity
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation. / Baron, Frédéric; Storb, Rainer; Storer, Barry E.; Maris, Michael B.; Niederwieser, Dietger; Shizuru, Judith A.; Chauncey, Thomas R.; Bruno, Benedetto; Forman, Stephen J.; McSweeney, Peter A.; Maziarz, Richard; Pulsipher, Michael A.; Agura, Edward D.; Wade, James; Sorror, Mohamed; Maloney, David G.; Sandmaier, Brenda M.

In: Journal of Clinical Oncology, Vol. 24, No. 25, 01.09.2006, p. 4150-4157.

Research output: Contribution to journalArticle

Baron, F, Storb, R, Storer, BE, Maris, MB, Niederwieser, D, Shizuru, JA, Chauncey, TR, Bruno, B, Forman, SJ, McSweeney, PA, Maziarz, R, Pulsipher, MA, Agura, ED, Wade, J, Sorror, M, Maloney, DG & Sandmaier, BM 2006, 'Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation', Journal of Clinical Oncology, vol. 24, no. 25, pp. 4150-4157. https://doi.org/10.1200/JCO.2006.06.9914
Baron, Frédéric ; Storb, Rainer ; Storer, Barry E. ; Maris, Michael B. ; Niederwieser, Dietger ; Shizuru, Judith A. ; Chauncey, Thomas R. ; Bruno, Benedetto ; Forman, Stephen J. ; McSweeney, Peter A. ; Maziarz, Richard ; Pulsipher, Michael A. ; Agura, Edward D. ; Wade, James ; Sorror, Mohamed ; Maloney, David G. ; Sandmaier, Brenda M. / Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 25. pp. 4150-4157.
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abstract = "Purpose: Several studies have investigated the feasibility of allogeneic hematopoietic cell transplantations (HCTs) after reduced-intensity conditioning in patients who experienced relapse after myeloablative HCT. Although most studies showed relatively low nonrelapse mortality (NRM) rates and encouraging short-term results, it has yet to be defined which patients would benefit most from these approaches. Patients and Methods: We analyzed data from 147 patients with hematologic malignancies who experienced treatment failure with conventional autologous (n = 135), allogeneic (n = 10), or syngeneic (n = 2) HCT and were treated with HLA-matched related (n = 62) or unrelated (n = 85) grafts after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Results: Three-year probabilities of NRM, relapse, and overall survival were 32{\%}, 48{\%}, and 27{\%}, respectively, for related recipients, and 28{\%}, 44{\%}, and 44{\%}, respectively, for unrelated recipients. The best outcomes were observed in patients with non-Hodgkin's lymphoma, whereas patients with multiple myeloma and Hodgkin's disease had worse outcomes as a result of high incidences of relapse and progression. Being in partial remission (PR) or complete remission (CR) at HCT (P = .002) and developing chronic graft-versus-host disease (GVHD; P = .03) resulted in lower risks of relapse and progression. Factors associated with better overall survival were PR or CR (P = .01) and lack of comorbidity (P = .03) at HCT and absence of acute GVHD after HCT (P = .06). Conclusion: Encouraging outcomes were seen with allogeneic HCT after nonmyeloablative conditioning in selected patients who had experienced relapse after a high-dose HCT, particularly in patients with non-Hodgkin's lymphoma. Results with unrelated grafts were comparable with results with related grafts.",
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T1 - Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation

AU - Baron, Frédéric

AU - Storb, Rainer

AU - Storer, Barry E.

AU - Maris, Michael B.

AU - Niederwieser, Dietger

AU - Shizuru, Judith A.

AU - Chauncey, Thomas R.

AU - Bruno, Benedetto

AU - Forman, Stephen J.

AU - McSweeney, Peter A.

AU - Maziarz, Richard

AU - Pulsipher, Michael A.

AU - Agura, Edward D.

AU - Wade, James

AU - Sorror, Mohamed

AU - Maloney, David G.

AU - Sandmaier, Brenda M.

PY - 2006/9/1

Y1 - 2006/9/1

N2 - Purpose: Several studies have investigated the feasibility of allogeneic hematopoietic cell transplantations (HCTs) after reduced-intensity conditioning in patients who experienced relapse after myeloablative HCT. Although most studies showed relatively low nonrelapse mortality (NRM) rates and encouraging short-term results, it has yet to be defined which patients would benefit most from these approaches. Patients and Methods: We analyzed data from 147 patients with hematologic malignancies who experienced treatment failure with conventional autologous (n = 135), allogeneic (n = 10), or syngeneic (n = 2) HCT and were treated with HLA-matched related (n = 62) or unrelated (n = 85) grafts after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Results: Three-year probabilities of NRM, relapse, and overall survival were 32%, 48%, and 27%, respectively, for related recipients, and 28%, 44%, and 44%, respectively, for unrelated recipients. The best outcomes were observed in patients with non-Hodgkin's lymphoma, whereas patients with multiple myeloma and Hodgkin's disease had worse outcomes as a result of high incidences of relapse and progression. Being in partial remission (PR) or complete remission (CR) at HCT (P = .002) and developing chronic graft-versus-host disease (GVHD; P = .03) resulted in lower risks of relapse and progression. Factors associated with better overall survival were PR or CR (P = .01) and lack of comorbidity (P = .03) at HCT and absence of acute GVHD after HCT (P = .06). Conclusion: Encouraging outcomes were seen with allogeneic HCT after nonmyeloablative conditioning in selected patients who had experienced relapse after a high-dose HCT, particularly in patients with non-Hodgkin's lymphoma. Results with unrelated grafts were comparable with results with related grafts.

AB - Purpose: Several studies have investigated the feasibility of allogeneic hematopoietic cell transplantations (HCTs) after reduced-intensity conditioning in patients who experienced relapse after myeloablative HCT. Although most studies showed relatively low nonrelapse mortality (NRM) rates and encouraging short-term results, it has yet to be defined which patients would benefit most from these approaches. Patients and Methods: We analyzed data from 147 patients with hematologic malignancies who experienced treatment failure with conventional autologous (n = 135), allogeneic (n = 10), or syngeneic (n = 2) HCT and were treated with HLA-matched related (n = 62) or unrelated (n = 85) grafts after conditioning with 2 Gy of total-body irradiation with or without fludarabine. Results: Three-year probabilities of NRM, relapse, and overall survival were 32%, 48%, and 27%, respectively, for related recipients, and 28%, 44%, and 44%, respectively, for unrelated recipients. The best outcomes were observed in patients with non-Hodgkin's lymphoma, whereas patients with multiple myeloma and Hodgkin's disease had worse outcomes as a result of high incidences of relapse and progression. Being in partial remission (PR) or complete remission (CR) at HCT (P = .002) and developing chronic graft-versus-host disease (GVHD; P = .03) resulted in lower risks of relapse and progression. Factors associated with better overall survival were PR or CR (P = .01) and lack of comorbidity (P = .03) at HCT and absence of acute GVHD after HCT (P = .06). Conclusion: Encouraging outcomes were seen with allogeneic HCT after nonmyeloablative conditioning in selected patients who had experienced relapse after a high-dose HCT, particularly in patients with non-Hodgkin's lymphoma. Results with unrelated grafts were comparable with results with related grafts.

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