Abstract

The aim of this study was to compare the outcome of allogeneic HSCT after myeloablative versus reduced intensity conditioning (RIC) for lymphoma.

From January 1984 to June 2004, 87 patients underwent HSCT for lymphoma (including 41 patients with RIC, all grafted after May 1998). The diagnoses were 15 and 24 aggressive, 18 and 17 indolent and 8 and 5 HD lymphomas, in the RIC and myeloablative groups, respectively. There were 64 males and 23 females. The median age was 40 (16–61). The donors were 3 identical twins, 55 related and 29 unrelated donors. The conditioning was based on chemotherapy only in 32 and 8 and irradiation in combination with chemotherapy in 9 and 38 patients (p<0.001), in the RIC and myeloablative groups, respectively. Immunosuppression consisted of MTX and CsA in 68, CsA and MMF in 10, MTX or CsA in 4, T-cell depletion in 2 and 3 patients had no prophylaxis. In the RIC group the median age was significantly higher 49 (25–61) years than in the myeloablative group 38 (16–53) years (p<0.001). PBSC was used in 36 (88%) patients in the RIC group versus 17 (37%) (p<.001) in the myeloablative group.

The causes of deaths were 11 infections, 10 relapses, 6 EBV-lymphomas, 6 related to toxicity and 3 to GVHD and 1 renal cancer. Conclusions: Long term survival was seen in more than 50 % of patients with relapsing lymphoma after allogeneic HSCT. EBV lymphoma was the cause of death in 7% of the patients. The patient survival, TRM and relapse outcomes were similar after RIC and myeloablative conditioning but each subgroup is small. In the RIC group the patients were older, grafted in more advanced disease and the follow up shorter compared to the myeloablative group, therefore the results must be interpreted with care.

Results

RICMyeloablativep
GVHD (absolute incidence)    
Acute II-IV 43% 16% ns 
Chronic 32% 57% 0.06 
Outcome (2-years probability)    
TRM 25% 39% ns 
Relapse 21% 16% ns 
Patient survival 61% 54% ns 
RICMyeloablativep
GVHD (absolute incidence)    
Acute II-IV 43% 16% ns 
Chronic 32% 57% 0.06 
Outcome (2-years probability)    
TRM 25% 39% ns 
Relapse 21% 16% ns 
Patient survival 61% 54% ns 

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