Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation

Narendranath Epperla, Mehdi Hamadani, Kwang W. Ahn, Fiona He, Dheeraj Kodali, Ariel Kleman, Parameswaran N. Hari, Marcelo Pasquini, Timothy S. Fenske, Michael D. Craig, Abraham S. Kanate, Veronika Bachanova

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Outcome and management of patients who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) has evolved in the recent decade. Using a multi-institutional retrospective database we report the predictive factors and survival of lymphoma patients who relapse after allo-HCT. We evaluated 495 allo-HCT recipients transplanted between 2000 and 2015 at 3 academic US medical centers. Landmark analysis evaluating predictive factors was performed at 1 month after allo-HCT relapse with a primary endpoint of postrelapse overall survival (PR-OS). A total of 175 lymphoma patients (35%) experienced relapse after allo-HCT. Of these, 126 patients, median age 46 years (range, 19 to 71), were assessable. Most patients (86%) received subsequent therapy; 80 patients received targeted agents and 19 donor lymphocyte infusion. On univariate analysis median PR-OS for patients with Hodgkin lymphoma was 47.9 months compared with 11.3 months in patients with indolent and 10.1 months in aggressive non-Hodgkin lymphoma (P =.04). On multivariate analysis postrelapse therapy administration (no therapy versus targeted therapy: hazard ratio,.21 [95% confidence interval,.10 to.45]; no therapy versus nontargeted therapy: hazard ratio,.26 [95% confidence interval,.11 to.57]), late relapse 130 days after allo-HCT (relative to early relapse: hazard ratio,.25; P <.001), and Eastern Cooperative Oncology Group performance status of 0 to 1 (versus Eastern Cooperative Oncology Group performance status ≥ 2: hazard ratio,.49; P =.003) were associated with a significantly reduced risk of mortality. Patients relapsing ≥ 130 days from the time of allo-HCT yielded PR-OS of 48.8 months compared with 6.5 months in patients with early relapse (P <.001). Our data suggest that in the modern era, therapies used for patients experiencing lymphoma relapse after allo-HCT can extend survival.

Original languageEnglish (US)
Pages (from-to)983-988
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • Allo-HCT
  • Allogeneic hematopoietic cell transplantation
  • Lymphoma
  • PR-OS
  • Postrelapse survival

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