Allogeneic and Autologous Transplantation In Patients with Aggressive B- and T-Cell Lymphomas

Abstract 3544

The prognosis of patients with aggressive relapsed or refractory B- or T-cell lymphomas is poor with conventional chemotherapy. Therefore, high-dose chemotherapy followed by autologous or allogeneic transplantation is the treatment of choice in these patients.

We investigated the outcome of patients with aggressive B- or T-cell lymphomas transplanted between 1998 and 2009 in one centre. A total of 104 patients with diffuse large B-cell lymphoma (DLBCL) (n=69) and T-lymphoblastic lymphoma (T-LBL) (n=35) received autologous (auto) (n=66; DLBCL: 68%; T-LBL: 32%) or allogeneic (allo) (n=38; DLBCL: 63%; T-LBL: 37%) HSCT. Patients ineligible for auto transplantation, who did not respond to prior chemotherapy or had bone marrow involvement, were assigned to allo transplantation. Allo HSCT recipients were more likely to have high risk disease (higher disease stage, more prior chemotherapy regimens, resistant disease). Recipients of auto HCT were more likely to have chemosensitive disease at HSCT compared to patients at allo HCT (70% vs. 30%). Median age at transplantation was 52 years for auto and 42 years for allo HSCT. Median follow up was 12.7 (0.2-106) months after auto and 6.4 (0.4-111) months after allo transplantion. All patients with auto HSCT received BEAM and patients with allo HSCT TBI-based preparative regimen (myeloablative: n=23; reduced intensity: n=15).

In the cohort of 104 patients the estimated 5-years overall (OS) and progression free survival (PFS) were 38% and 44%, respectively. There was no difference in OS and PFS between DLBCL and T-LBL (p=0.44). The estimated OS and PFS after allo HCT were significant lower (25% and 37%) than after auto HCT (45% and 47%; p=0.008 and p=0.03) caused by outcome differences in patients with DLBCL (p=0.02). Interestingly, OS and PFS were not different in patients with T-LBL transplanted with auto or allo HSCT (p=0.55 [OS] and p=0.34 [PFS]). The estimated PFS was significantly better in chemosensitive than chemorefractory patients (p=0.0001), however the OS and PFS were similar in chemosensitive group of patients regardless auto or allo HSCT (PFS: 50% vs. 51%; p=0.57; OS: 49% (auto) vs 32% (allo); p=0.19). Treatment related mortality (TRM) at day 100 was 18% after allo HSCT compared to 8% after auto.

In conclusion, allo HSCT in patients with aggressive B- or T-cell lymphoma ineligible for auto transplantation is an attractive treatment option for these patients with high risk of relapse with a considerably low TRM. The response status at the moment of HSCT is the most important parameter affecting either OS or PFS.