Patients with Lymphoplasmacytic Lymphoma Can Be Salvaged with Autologous Stem Cell Transplantation, Irrespectively of the Number of Previous Treatment Lines. Analysis of 146 Cases from the European Bone Marrow Transplant Registry (EBMT).

Lymphoplasmacytic Lymphoma (LPL) is a relatively rare low-grade lymphoma which primarily affects elderly patients. Standard doses of alkylating agents, purine analogues and anti-CD20 monoclonal antibody effect response rates of up to 60%. However, complete response is infrequent and there is no cure. Due to indolent nature of the disease and older patients with comorbidities, evaluation of the role of high dose therapy with transplant has been infrequent in the past. Here we report a retrospective multicentre study of 146 LPL patients (94 male, 52 female), who underwent autologous stem cell transplantation (ASCT) between 1992 and 2004.

The median age was 60 years (54–67) and median time from diagnosis to transplant was 62 months (5–119). Twenty-six patients (18%) were in CR1, 35 (24%) in CR2, 30 (20%) in ≥CR3, 45 (31%) in PR, 10 (7%) primary refractory at transplant. Combination of GCSF with either Cyclophosphamide, ESHAP or AraC were mainly the stem cell mobilisation regimens used, and 18 patients with extensive prior use of purine analogues, required second attempt for harvesting. The conditioning regimens used were BEAM, Cyclophosphamide/TBI or Melphalan/TBI. The source of stem cells was PBSC in 129, BM in 11 and both in 6 patients. All patients except one had successful engraftment. With a median follow-up of 12 months (2–126), 131 (90%) patients are alive and 15 (10%) dead. Thirteen patients died from disease progression and 2 from regimen toxicity. Actuarial non- relapse mortality was 2.4% at 1 and 2 years. The actuarial OS was 90% at 1 year, 79% at 3 years and 69% at 5 years. The probability of relapse was 80% at 1 year, 53% at 3 years and 39% at 5 years. Relapse rate was not statistically significant for patients with chemosensitive disease. In conclusion this study shows that ASCT is safe, and a significant proportion of previously multitreated LPL patients can be salvaged and sustain prolonged DFS.