Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan

Bone Marrow Transplant. 2005 Aug;36(3):205-13. doi: 10.1038/sj.bmt.1705027.

Abstract

We conducted a nation-wide survey of 112 adult Japanese patients who underwent reduced-intensity stem cell transplantation (RIST) from 1999 to 2002. Underlying diseases included indolent (n=45), aggressive (n=58) and highly aggressive lymphomas (n=9). Median age of the patients was 49 years. A total of 40 patients (36%) had relapsed diseases after autologous stem cell transplantation and 36 patients (32%) had received radiotherapy. RIST regimens were fludarabine-based (n=95), low-dose total body irradiation-based (n=6) and others (n=11). Cumulative incidences of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were, respectively, 49 and 59%. Cumulative incidences of progression and progression-free mortality were 18 and 25%, respectively. With a median follow-up of 23.9 months, 3-year overall survival rates were 59%. A multivariate analysis identified three significant factors for progression, which are history of radiation (relative risk (RR) 3.45, confidential interval (CI) 1.12-10.0, P=0.03), central nervous system involvement (RR 6.25, CI 2.08-20.0, P=0.001) and development of GVHD (RR 0.28, CI 0.090-0.86, P=0.026). RIST may have decreased the rate of transplant-related mortality, and GVHD may have induced a graft-versus-lymphoma effect. However, whether or not these potential benefits can be directly translated into improved patient survival should be evaluated in further studies.

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Female
  • Graft vs Host Disease
  • Graft vs Tumor Effect
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Japan
  • Lymphoma / mortality
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk
  • Stem Cell Transplantation
  • Time Factors
  • Treatment Outcome