Allogeneic bone marrow transplantation for low-grade lymphoma

Koen Van Besien, Kathleen A. Sobocinski, Philip A. Rowlings, Sandra C. Murphy, James Olen Armitage, Michael R. Bishop, Ok Kyong Chaekal, Robert Peter Gale, John P. Klein, Hillard M. Lazarus, Philip L. McCarthy, John M.M. Raemaekers, Josy Reiffers, Gordon L. Phillips, Anton V.M.B. Schattenberg, Leo F. Verdonck, Julie Marie Vose, Mary M. Horowitz

Research output: Contribution to journalArticle

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Abstract

Advanced low-grade lymphomas are usually incurable with conventional- dose chemotherapy. It is uncertain whether cures are possible with high-dose therapy and bone marrow transplant from a human leukocyte antigen (HLA)- identical sibling. We sought to determine the outcome of HLA-identical sibling bone marrow transplants in advanced low-grade lymphoma in an observational study of 113 patients conducted at 50 centers participating in the International Bone Marrow Transplant Registry (IBMTR). The median patient age was 38 years (range, 15 to 61). Eighty percent had stage IV disease at the time of transplantation. The median number of prior chemotherapy regimens was two (range, 0 to 5). Thirty-eight percent had refractory disease and 29% a Karnofsky performance score (KPS) less than 80%. All patients underwent allogeneic bone marrow transplantation from a HLA-identical sibling donor. The conditioning regimen included total-body irradiation (TBI) in 82% of patients; cyclosporine was used for graft-versus-host disease prophylaxis in 74%. Survival, disease-free survival, recurrence rate, treatment-related mortality, and causes of death were determined. Three-year probabilities of recurrence, survival, and disease-free survival were 16% [95% confidence interval [CI], 9% to 27%), 49% (95% CI, 39% to 60%) and 49% (95% CI, 39% to 59%), respectively. Higher survival was associated with pretransplant KPS ≤90%, chemotherapy-sensitive disease, use of a TBI-containing conditioning regimen, and age less than 40 years. We conclude that high-dose therapy followed by transplantation from a HLA-identical sibling leads to prolonged survival in some patients with advanced low-grade lymphoma. Most mortality is treatment-related, and recurrences are rare.

Original languageEnglish (US)
Pages (from-to)1832-1836
Number of pages5
JournalBlood
Volume92
Issue number5
StatePublished - Sep 1 1998

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Homologous Transplantation
Bone Marrow Transplantation
Non-Hodgkin's Lymphoma
HLA Antigens
Bone
Siblings
Transplants
Chemotherapy
Survival
Whole-Body Irradiation
Bone Marrow
Confidence Intervals
Recurrence
Drug Therapy
Disease-Free Survival
Transplantation
Irradiation
Mortality
Graft vs Host Disease
Therapeutics

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Van Besien, K., Sobocinski, K. A., Rowlings, P. A., Murphy, S. C., Armitage, J. O., Bishop, M. R., ... Horowitz, M. M. (1998). Allogeneic bone marrow transplantation for low-grade lymphoma. Blood, 92(5), 1832-1836.

Allogeneic bone marrow transplantation for low-grade lymphoma. / Van Besien, Koen; Sobocinski, Kathleen A.; Rowlings, Philip A.; Murphy, Sandra C.; Armitage, James Olen; Bishop, Michael R.; Chaekal, Ok Kyong; Gale, Robert Peter; Klein, John P.; Lazarus, Hillard M.; McCarthy, Philip L.; Raemaekers, John M.M.; Reiffers, Josy; Phillips, Gordon L.; Schattenberg, Anton V.M.B.; Verdonck, Leo F.; Vose, Julie Marie; Horowitz, Mary M.

In: Blood, Vol. 92, No. 5, 01.09.1998, p. 1832-1836.

Research output: Contribution to journalArticle

Van Besien, K, Sobocinski, KA, Rowlings, PA, Murphy, SC, Armitage, JO, Bishop, MR, Chaekal, OK, Gale, RP, Klein, JP, Lazarus, HM, McCarthy, PL, Raemaekers, JMM, Reiffers, J, Phillips, GL, Schattenberg, AVMB, Verdonck, LF, Vose, JM & Horowitz, MM 1998, 'Allogeneic bone marrow transplantation for low-grade lymphoma', Blood, vol. 92, no. 5, pp. 1832-1836.
Van Besien K, Sobocinski KA, Rowlings PA, Murphy SC, Armitage JO, Bishop MR et al. Allogeneic bone marrow transplantation for low-grade lymphoma. Blood. 1998 Sep 1;92(5):1832-1836.
Van Besien, Koen ; Sobocinski, Kathleen A. ; Rowlings, Philip A. ; Murphy, Sandra C. ; Armitage, James Olen ; Bishop, Michael R. ; Chaekal, Ok Kyong ; Gale, Robert Peter ; Klein, John P. ; Lazarus, Hillard M. ; McCarthy, Philip L. ; Raemaekers, John M.M. ; Reiffers, Josy ; Phillips, Gordon L. ; Schattenberg, Anton V.M.B. ; Verdonck, Leo F. ; Vose, Julie Marie ; Horowitz, Mary M. / Allogeneic bone marrow transplantation for low-grade lymphoma. In: Blood. 1998 ; Vol. 92, No. 5. pp. 1832-1836.
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abstract = "Advanced low-grade lymphomas are usually incurable with conventional- dose chemotherapy. It is uncertain whether cures are possible with high-dose therapy and bone marrow transplant from a human leukocyte antigen (HLA)- identical sibling. We sought to determine the outcome of HLA-identical sibling bone marrow transplants in advanced low-grade lymphoma in an observational study of 113 patients conducted at 50 centers participating in the International Bone Marrow Transplant Registry (IBMTR). The median patient age was 38 years (range, 15 to 61). Eighty percent had stage IV disease at the time of transplantation. The median number of prior chemotherapy regimens was two (range, 0 to 5). Thirty-eight percent had refractory disease and 29{\%} a Karnofsky performance score (KPS) less than 80{\%}. All patients underwent allogeneic bone marrow transplantation from a HLA-identical sibling donor. The conditioning regimen included total-body irradiation (TBI) in 82{\%} of patients; cyclosporine was used for graft-versus-host disease prophylaxis in 74{\%}. Survival, disease-free survival, recurrence rate, treatment-related mortality, and causes of death were determined. Three-year probabilities of recurrence, survival, and disease-free survival were 16{\%} [95{\%} confidence interval [CI], 9{\%} to 27{\%}), 49{\%} (95{\%} CI, 39{\%} to 60{\%}) and 49{\%} (95{\%} CI, 39{\%} to 59{\%}), respectively. Higher survival was associated with pretransplant KPS ≤90{\%}, chemotherapy-sensitive disease, use of a TBI-containing conditioning regimen, and age less than 40 years. We conclude that high-dose therapy followed by transplantation from a HLA-identical sibling leads to prolonged survival in some patients with advanced low-grade lymphoma. Most mortality is treatment-related, and recurrences are rare.",
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AU - Chaekal, Ok Kyong

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AU - Klein, John P.

AU - Lazarus, Hillard M.

AU - McCarthy, Philip L.

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AU - Reiffers, Josy

AU - Phillips, Gordon L.

AU - Schattenberg, Anton V.M.B.

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N2 - Advanced low-grade lymphomas are usually incurable with conventional- dose chemotherapy. It is uncertain whether cures are possible with high-dose therapy and bone marrow transplant from a human leukocyte antigen (HLA)- identical sibling. We sought to determine the outcome of HLA-identical sibling bone marrow transplants in advanced low-grade lymphoma in an observational study of 113 patients conducted at 50 centers participating in the International Bone Marrow Transplant Registry (IBMTR). The median patient age was 38 years (range, 15 to 61). Eighty percent had stage IV disease at the time of transplantation. The median number of prior chemotherapy regimens was two (range, 0 to 5). Thirty-eight percent had refractory disease and 29% a Karnofsky performance score (KPS) less than 80%. All patients underwent allogeneic bone marrow transplantation from a HLA-identical sibling donor. The conditioning regimen included total-body irradiation (TBI) in 82% of patients; cyclosporine was used for graft-versus-host disease prophylaxis in 74%. Survival, disease-free survival, recurrence rate, treatment-related mortality, and causes of death were determined. Three-year probabilities of recurrence, survival, and disease-free survival were 16% [95% confidence interval [CI], 9% to 27%), 49% (95% CI, 39% to 60%) and 49% (95% CI, 39% to 59%), respectively. Higher survival was associated with pretransplant KPS ≤90%, chemotherapy-sensitive disease, use of a TBI-containing conditioning regimen, and age less than 40 years. We conclude that high-dose therapy followed by transplantation from a HLA-identical sibling leads to prolonged survival in some patients with advanced low-grade lymphoma. Most mortality is treatment-related, and recurrences are rare.

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