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Medline ® Abstract for Reference 77

of 'Treatment of relapsed or refractory mantle cell lymphoma'

Allogeneic stem cell transplantation following reduced-intensity conditioning can induce durable clinical and molecular remissions in relapsed lymphomas: pre-transplant disease status and histotype heavily influence outcome.
Corradini P, Dodero A, Farina L, Fanin R, Patriarca F, Miceli R, Matteucci P, Bregni M, ScimèR, Narni F, Pogliani E, Locasciulli A, Milani R, Carniti C, Bacigalupo A, Rambaldi A, Bonifazi F, Olivieri A, Gianni AM, Tarella C, Gruppo Italiano Trapianto di Midollo Osseo
Leukemia. 2007;21(11):2316. Epub 2007 Jun 28.
The safety and efficacy of reduced-intensity conditioning (RIC) followed by allogeneic stem cell transplantation (SCT) for relapsed lymphomas remains unresolved. We conducted a prospective, multicentered, phase II trial. A total of 170 relapsed/refractory lymphomas received a RIC regimen followed by SCT from sibling donors. The primary study end point was non-relapse mortality (NRM). Histologies were non-Hodgkin's lymphomas (NHL) (indolent (LG-NHL), n=63; aggressive (HG-NHL), n=61; mantle cell lymphoma (MCL), n=14) and Hodgkin's disease (HD, n=32). Median follow-up was 33 months (range, 12-82). The results show that frequencies were as follows: cumulative NRM at 3 years, 14%; acute and chronic graft-versus-host disease (GVHD) 35 and 52%, respectively; 3-year overall survival (OS), 69% for LG-NHL, 69% for HG-NHL, 45% for MCL and 32% for HD (P=0.058); and 3-year relapse incidence, 29, 31, 35 and 81%, respectively (P<0.001).Relapse risk differed significantly at 3 years between follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL) (14 versus 46%, P=0.04). Molecular remission occurred in 94 and 40% (P=0.002) of patients with FL and CLL, respectively. On multivariate analysis, OS was influenced by chemorefractory disease (hazard ratio (HR)=3.6), diagnosis of HD (HR=3.5), and acute GVHD (HR=5.9). RIC allogeneic SCT is a feasible and effective salvage strategy in both indolent and aggressive NHL.
Division of Hematology and Bone Marrow Transplantation, Department of Hematology, Istituto Nazionale per lo Studio e la Cura dei Tumori, University of Milano, Milan, Italy. paolo.corradini@istitutotumori.mi.it