Retrospective analysis of 77 patients finds allogeneic stem cell transplantation is associated with lower overall survival in patients with aggressive rather than indolent Non-Hodgkin Lymphoma

On 6^th February 2017, Ana M. Picleanu from the Hospital Filantropia, Craiova, Romania, and colleagues published in the Annals of Hematology findings from their retrospective analysis of NHL patients who received an Allogeneic Hematopoietic Stem Cell Transplant (allo-SCT) from January 1995 to December 2014.

In total, the medical records of 77 patients were included in the analysis; median age at time of allo-SCT was 50 years (range, 19–68 years). The histological NHL subtypes were: FL (n=31), DLBCL (n=17), MCL (n=15), T-cell NHL (n=12), and MZL (n=2). Thirty-three patients (43%) had iNHL while the remaining 44 patients (57%) had aggressive NHL (12 of these patients’ disease was of T-cell origin).

Key Highlights:

• Median follow-up time post-allo-SCT = 23 months (range, 0–232 months)
• OS = 53.5% (95% CI, 42–64%); PFS = 52.3% (95% CI, 40–63%); 9 pts progressed
• Forty-four pts died; causes included GvHD (18, 44%), infections (11, 25%), secondary malignancies (4, 9%), and veno-occlusive disease (2, 5%)
• Age, type of NHL (aggressive vs indolent), and pre-allo-SCT response had statistically significant impact in OS (P < 0.05)
  • OS in pts ≤60 years old vs >60 years old = 58% (95% CI, 45–69%) and 24% (95% CI, 4–53%), respectively (P < 05)
  • OS in pts in CR pre-allo-SCT vs PR vs PD = 60% (95% CI, 44–73%), 55% (95% CI, 32–73%), and 0%, respectively (P < 0.05)
  • OS in pts with aggressive vs indolent NHL = 47% (95% CI, 32–61%) and 63% (44–77%), respectively
• 5-yr OS in aggressive NHL = 46% TCL, 47% MCL, and 27% DLBCL
• Younger age and pre-allo-SCT response had favorable impact on PFS
  • PFS in pts ≤60 years old vs >60 years old = 57% (95% CI, 44–68%) and 24% (95% CI, 4–53%), respectively
  • PFS in pts in CR pre-allo-SCT vs PR vs PD = 58% (95% CI, 42–71%) and 55% (95% CI, 32–73%) and 0%, respectively
• 2 years post-allo-SCT, NRM = 39% (95% CI, 27–50%); cumulative incidence of relapse = 0.13 (95% CI, 0.04–0.22)
• In multivariate analysis:
  • 5-yr OS in good prognosis group (≤60 years, chemosensitive disease pre-allo-SCT, indolent NHL) vs bad prognosis group = 69% and 34%, respectively (P < 0.005)
  • Hazard associated with death for refractory disease and aggressive NHL increased by factor of 4.88 and 2.05, respectively

At time of analysis, 33 patients are still alive; acute GvHD and chronic GvHD were reported in 9 patients (27.3%) and 15 patients (45.5%), respectively. CMV reactivation occurred in 8 patients (24.2%) and invasive pulmonary aspergillosis was reported in 5 patients (15.2%).

The authors stated that their study indicates that allo-SCT is “a reasonable therapeutic option” for younger patients with chemosensitive disease, particularly those with indolent NHL. They reported that allo-SCT for aggressive NHL is associated with a lower OS and poorer outcome than patients treated for indolent NHL. However, the authors state that young patients with aggressive NHL should still be considered for allo-SCT if their disease is chemosensitive. The authors also concluded that patients with non-responsive disease and those older than 60 years should be administered alternative therapies other than allo-SCT.

Abstract:

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a therapeutic option for relapsed, advanced, and otherwise incurable non-Hodgkin's lymphomas (NHL) suggested by the existence of a graft-versus-lymphoma effect. The main complications are graft-versus-host disease and infections. We performed a retrospective analysis of patients with NHL, who received an allo-SCT between January 1995 and December 2014. The parameters that had an impact on overall survival were age ≤60 years old, chemosensitive disease pre-allo-SCT, and indolent NHL histology. The parameters that had an impact on progression-free survival were age ≤60 years old and chemosensitive disease pre-allo-SCT. Only aggressive NHL histology and refractory disease pre-allo-SCT showed an increased risk of death in the multivariate model. The use of allo-SCT for young patients with multiple relapsed chemosensitive indolent NHL is a suitable option. Despite poor prognosis, young aggressive NHL patients can be considered for allo-SCT provided they have chemosensitive disease.