Although the increasing of novel drugs has improved the survival outcomes with non-Hodgkin lymphoma (NHL), about 50% of them have failed to respond or relapse and small fraction only could be cured by autologous hematopoietic stem cell transplantation (autoHSCT). So, allogeneic hematopoietic stem cell transplantation (alloHSCT) considers as a definitive modality of cure for relapsed or refractory NHL. However, it still associated with problematic concerns including graft-versus-host disease (GVHD), relapse, and non-relapse death. The success of alloHSCT is based on the measurement of survival duration with clinically significant negative events such as a novel composite endpoint of GVHD and relapse-free survival (GRFS) where the events were acute GVHD grade 3-4, moderate to severe chronic GVHD, relapse or death. Based on these reasons, we assessed GRFS and attempt to identify the prognostic factors of GRFS in patients with relapse/refractory NHL.
We retrospectively analyzed a consecutive 82 adult patients with relapse/refractory NHL who received an alloHSCT as salvage purpose between January 2008 and March 2016.
Median age at alloHSCT and follow-up duration were 38 (19-65) years and 28 months (1-112 months), respectively. 73 patients (89%) in aggressive histologic subgroup, 37 patients (45.1%) of bone marrow involvement, and favorable disease status as CR/PR at alloHSCT was in 45 patients (54.9%). 32 patients (65%) were received autoHSCT prior to alloHSCT. Majority (n=78, 95%) received reduced intensity conditioning regiemens, and donor type was HLA matched related (n=27, 33%), matched unrelated (n=45, 55%) and haploidentical (n=10, 12%).
The 3-year overall survival (OS), progression-free survival (PFS), the cumulative incidence of relapse (CIR), and cumulative incidence of non-relapse mortality (CI of NRM) were 50.9%, 44.4%, 34.8%, and 20.0%, respectively. Also, the 1-year OS, PFS, CIR, and CI of NRM were 66.7%, 56.8%,19.7% and 17.3%, respectively, and the 1-year GRFS was 40.7% in the group of all relapse/refractory NHL. By the multivariate analysis, received more than the third-line chemotherapy before the transplant, high IPI scoring at diagnosis, and unfavorable disease status as stable disease/ progressive disease at alloHSCT were associated with a worse GRFS at 1-year post alloHSCT (HR 1.88, p=0.045; HR 1.92, p=0.025; HR 1.94, p=0.024).
GRFS is a useful endpoint that is worth investigating tool as a maker of favorable HCT in lymphoma. These data suggest that the early adaptation of alloHSCT in the group of chemosensitive relapse with low-risk IPI score provide the highest GRFS rates as successful HCT in relapse/refractory NHL.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.