Reduced intensity regimens (RIR) have largely replaced conventional myeloablative regimens (CMR) for patients with NHL undergoing allogeneic transplant. However, the impact of dose reduction on relapse has not been extensively studied. We performed a retrospective analysis of 88 patients conditioned with CMR (n=48) and a RIR (n=40) of fludarabine 125mg/m2 and melphalan 140mg/m2. GVHD prophylaxis was with cyclosporine + MTX +/− prednisone for CMR and cyclosporine + MMF +/− MTX for the RIR.

CMRRIRP Value
N 48 40  
Low grade B-cell 18 16 NS 
Intermediate grade B-cell 16 12 NS 
Mantle cell 10 5 NS 
T cell 4 7 NS 
Age (years, median, range) 44 (18–54) 51 (20–67) 0.0002 
No of prior regimens (median) 3 2 0.02 
Previous autologous transplant 5 16 0.002 
Chemosensitivity at transplant 24 31 0.007 
FTBI regimen 41 0 <0.0001 
MUD 8 17 0.009 
PBSC 16 36 0.0001 
Median follow-up (months,range) 65 (33-95) 20 (6-42)  
CMRRIRP Value
N 48 40  
Low grade B-cell 18 16 NS 
Intermediate grade B-cell 16 12 NS 
Mantle cell 10 5 NS 
T cell 4 7 NS 
Age (years, median, range) 44 (18–54) 51 (20–67) 0.0002 
No of prior regimens (median) 3 2 0.02 
Previous autologous transplant 5 16 0.002 
Chemosensitivity at transplant 24 31 0.007 
FTBI regimen 41 0 <0.0001 
MUD 8 17 0.009 
PBSC 16 36 0.0001 
Median follow-up (months,range) 65 (33-95) 20 (6-42)  
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CMR were significantly associated with a lower rate of relapse (RR) of 15% versus 38% after RIR (p=0.017). The 1-year TRM was 38% for CMR and 24% for RIR (p=NS). Kaplan-Meier 2-year OS/PFS for CMR is 52%/48% versus 57%/48% for RIR (p=NS). When analyzed by diagnosis, CMR were significantly associated with decreased RR (10% vs 60%, p=0.004) for intermediate grade B-cell (figure 1). Univariate analysis of patient and treatment-related prognostic factors showed improved survival with chemosensitive disease; treatment intensity was the single predictor of relapse for the entire group, but, when stratified by diagnosis, for intermediate grade B-cell only. In conclusion, CMR provide better disease control for intermediate grade B-cell NHL.

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Figure

Topics:
recurrence risk, transplantation, cardiac mri, cyclosporine, chemosensitivity, fludarabine, follow-up, graft-versus-host disease, melphalan, prednisone

Author notes

Corresponding author

2005, The American Society of Hematology
2004
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