Appropriate Patient Selection Before Allogenic Stem Cell Transplantation (allo-SCT) and Chronic GvHD After Allo-SCT Would Be Necessary for Better Outcome of Chemorefractory Non-Hodgkin's Lymphomas-A Single Institute Retrospective Study-.

Allogenic stem cell transplantaion (allo-SCT) for non-Hodgkin's lymphomas (NHLs) may be curative for chemorefractory patients, but few studies are available to guide transplant decision making in this setting. It would be very important to assess the eligibilities of allo-SCT for NHLs. To clarify the possibilities and eligibilities of allo-SCT for aggressive NHLs and come out the better prognostic factors, we analyzed 18 NHL patients who underwent allo-SCT in our institute retrospectively.

There were 55 NHL patients who had been undergone allo-SCT in our institute from August 2001 to March 2009. Thirty-seven patients out of 55 were adult T-cell leukemia/lymphoma (ATLL) patients, and we excluded these 37 ATLL patients in this study so that eliminate selection bias. We analyzed about rest of 18 patents. We analyzed 3 years overall survival (OS), disease free survival (DFS), related factors such as gender, age, diagnosis, disease status, IPI, HCT-CI score, transplantation methods, acute GVHD, chronic GVHD, and causes of death.

Median age was 37.5 years old (19-63). Thirteen patients were male and 5 female. Diagnosis included FL (n=4), PTCL-u (n=3), MNKL (n=3), BL (n=2), DLBCL (n=2), ALCL (n=1), T-LBL (n=1), hepatosplenic lymphoma (n=1), and MF (n=1). Median overall survival time and disease free survival time after SCT were 215.5 days (6-2436) and 73 days (2-2436). Overall survival rate after SCT was 38.9%. IPI was Low in 2 patients, 8 L-I, 5 H-I, and 3 High. Low/L-I group showed significantly superior OS, DFS compare to H-I/High group (54% vs 0% p=0.0014, 56.3% vs 0% p=0.0112). HCT-CI scoring 0 in 12 patients, five 1, and only one patient scored over 2. HCT-CI score significantly related to OS after SCT in our cases (p=0.024). There were 13 sibling donors (included 5 HLA haplo-identical donors) and 5 unrelated donors (URD) (included 2 cord blood donors) in our cases. Ten patients received myeloablative conditioning and 8 reduced intensity conditioning (RIC). Disease status at SCT was CR in 5 patients, 7 PR, and 6 PD. Eleven patients died after SCT (3 a-GVHD, 2 disease progression, 2 sepsis, 1 TMA, 1 pneumonia, 1 invasive aspergillosis, and 1 liver failure). Five patients died within 100 days after SCT (three patients died within day 30). Six patients have been alive over 3 years (3 yrs OS, DFS: 33.3%, 27.8%). Seven patients were complicated grade 0-1 a-GVHD and 9 grade 2-4. Grade 0-1 group patients showed significantly superior DFS compare to grade 2-4 (p=0.0314). Five patients complained limited c-GVHD and 3 extensive. The patients group complained with c-GVHD showed better OS and DFS than asymptomatic group (53.6% vs 12.0% p=0.0062, 58.3% vs 12.5% p=0.0267). Four patients suffered relapse or progressive disease after SCT. Two out of these 4 patients showed GVL effect only with reducing immunosuppressive therapies.

Interestingly, about a-GVHD, grade 2-4 group obtained poor prognostic result compared to grade 0-1 group. On the other hand, the group which showed c-GVHD obtained better survival results. Our study was based on relatively small numbers of cases, but it might be showed that c-GVHD is important and GVL effect would be possibly existed. 3 years OS and DFS of allo-SCT for chemorefractory NHL in our institute were 33.3%, 27.8%, and NRM was 50%. Although it was not acceptable results, in some groups such as IPI Low/L-I, low scored HCT-CI groups, allo-SCT would be acceptable. Further studies including large patients numbers will be required.

No relevant conflicts of interest to declare.