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Long-term outcomes after reduced-intensity conditioning allogeneic stem cell transplantation for low-grade lymphoma: a survey by the French Society of Bone Marrow Graft Transplantation and Cellular Therapy (SFGM-TC)

From the Centre Hospitalier Universitaire (CHU) Pontchaillou, Rennes, France (SV, MB); CHU Edouard Herriot, Lyon, France (MM); CHU Saint-Louis, Paris, France (RP, LA, GS); CHU Purpan, Toulouse, France (MA); Institut Paoli-Calmettes, Marseille, France (DB); CHU du Haut-Levêque, Bordeaux, France (RT, NM); CHU Michallon, Grenoble, France (FG); CHU Archet, Nice, France (J-PC); CHU Hôtel Dieu, Nantes, France (PC); CHU Huriez, Lille, France (TF); CHU d’Angers, Angers, France (NI); CHU La Miletrie, Poitiers, France (MR); Centre Henri-Becquerel, Rouen, France (HT); CHU de la Pitié Salpetrière, Paris, France (J-PV); CHU Henri Mondor, Créteil, France (MK); Institut Gustave Roussy, Villejuif, France (J-HB); CHU de Brabois, Nancy, France (PB); CHU J. Minjoz, Besançon, France (ED); CHU Hautepierre, Strasbourg, France (BL)

Correspondence: Stéphane Vigouroux, MD, Service d’Hématologie Clinique, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35000 Rennes, France. E-mail: vigouroux.st{at}wanadoo.fr

Background and Objectives: High-dose chemotherapy with allogeneic stem cell transplantation (SCT) has proven to be a successful treatment for low-grade lymphoma (LGL), but is associated with considerable transplant-related mortality (TRM). In an effort to reduce toxic mortality while maintaining the graft-versus-leukemia effect, allogeneic SCT has been combined with a reduced-intensity conditioning (RIC) regimen. The aim of this study was to determine the outcome of patients with LGL treated with RIC allogeneic SCT.

Design and Methods: This retrospective multicenter study included 73 patients with relapsed or refractory LGL allografted after a RIC regimen between 1998 and 2005 whose data were recorded in a French registry.

Results: Patients received a median of three lines of therapy prior to RIC allogeneic SCT. The most widely used conditioning regimens were fludarabine + busulfan + antithymocyte globulin (n=43) and fludarabine + total body irradiation (n=21). Prior to allografting, patients were in complete response (CR; n=21), partial response (PR; n=33) or had chemoresistant disease (n=19). The median follow-up was 37 months (range, 16 to 77 months). In patients in CR, PR and chemoresistant disease, the 3-year overall survival rates were 66%, 64% and 32%, respectively, while the 3-year event-free survival rates were 66%, 52% and 32%, respectively. The 3-year cumulative incidences of TRM were 32%, 28% and 63%, respectively. The incidence of relapse was 9.6%.

Interpretation and Conclusions: Although associated with significant TRM, RIC allogeneic SCT in advanced chemosensitive disease leads to long-term survival.

Key words: RIC allogeneic transplantation, low-grade lymphoma.

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