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Lymphoma

An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation

Bone Marrow Transplantation volume 31, pages 667–678 (2003)Cite this article

Summary:

The role of allogeneic bone marrow transplantation in lymphoma remains uncertain. We have analyzed 1185 allogeneic transplants for lymphoma reported to the EBMT registry between 1982 and 1998 and compared the results with those of 14 687 autologous procedures performed over the same period. Patients receiving allogeneic transplants were subdivided according to histology: low-grade non-Hodgkin's lymphoma (NHL) 231 patients; intermediate-grade NHL 147 patients; high-grade NHL 255 patients; lymphoblastic NHL 314 patients; Burkitt's lymphoma 71 patients; and Hodgkin's disease 167 patients. These patients received allogeneic transplants as their first transplant procedure. Actuarial overall survival (OS) at 4 years from transplantation was: low-grade NHL 51.1%; intermediate-grade NHL 38.3%; high-grade NHL 41.2%; lymphoblastic lymphoma 42.0% years; Burkitt's lymphoma 37.1%; and Hodgkin's disease 24.7% years. These outcomes are relatively poor because of the high procedure-related mortality associated with these procedures, particularly in patients with Hodgkin's disease (51.7% actuarial procedure-related mortality at 4 years). Multivariate analysis showed that for all lymphomas apart from Hodgkin's disease, status at transplantation significantly affected outcome. A matched analysis was performed: for all categories of lymphoma, OS was better for autologous than for allogeneic transplantation. Relapse rate was better in the allogeneic group for low-, intermediate- and high-grade, and lymphoblastic NHL. It was equivalent for Burkitt's lymphoma and worse in the allogeneic group for Hodgkin's disease. Allogeneic transplantation appears to be superior to autologous procedures in terms of producing a lower relapse rate. The toxicity of allogeneic procedures must however be reduced before this translates into an improvement in OS.

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Acknowledgements

We gratefully acknowledge the collaboration of the large number of contributing transplant centers throughout and outside Europe. The following centers have registered over 50 lymphoma transplants with the EBMT, which have been used in this study:

Australia: Alfred Hospital, Melbourne; Royal Perth Hospital, Perth. Austria: AKH, Wein. Belgium: University Hospital, Leuven; Institut Jules Bordet, Brussels; Cliniques Universitaires St. Luc, Brussels; A.Z. Sint-Jan, Brugge; University of Liege, Liege. Croatia: University Hospital Centre-Rebro, Zagreb. Czech Republic: Charles University Hospital, Pilsen; Charles University Hospital, Praha. Denmark: Rigshospitalet, Copenhagen; Herlev Hospital, Herlev. Finland: Central Hospital, Turku; University Central Hospital, Helsinki. France: Hôpital Necker, Paris; Hôpital E. Herriot, Lyon Cedex 08; Hôpital Saint Antoine, Paris; Hotel Dieu, Paris; Institut Paoli Calmettes, Marseille; Hôpital St Jacques, Besançon; Centre Leon Berard, Lyon; Hôpital Nord, Saint Etienne; Centre Hospitalier Intercommunal, Creteil; Hotel Dieu, Nantes; Pitie-Salpetriere, Paris; Hôpital La Miletrie, Poitiers; Hôpital du Haut Leveque, Pessac; Hôpital A. Michallon, Grenoble; Hôpital Bretonneau, Tours; Centre Jaen Perrin, Clermont Ferrand; Hôpital Claude Huriez, Lille; Institut Gustave Roussy, Villejuif; Hôpital de Purpan, Toulouse; CHRU, Angers; Hôpital Percy, Clamart; Institut Gustave Roussy, Villejuif; Hôpital St. Louis, Paris. Germany: Universität Ulm, Ulm; Christian-Albrechts-University, Kiel; University Hospital, Essen; Medical School, Hannover; Universität Frankfurt, Frankfurt; Klinikum Nürnberg, Nürnberg; University of Saarland, Homburg/Saarland. Greece: The George Papanicolaou, Exokhi; Evangelismos Hospital, Athens. Italy: Ospedale San Martino, Genova; Centro Trapianti di Midollo Osseo, Cremona; Azienda Ospedaliera S. Giovanni, Torino; La Sapienza, Rome; Hospital San Orsola, Bologna; Centro Trapianti Midollo Osseo, Parma; IRCCS, Milano; Policlinico San Matteo, Pavia; Ospedale S. Camillo, Rome; Hospital San Maurizio, Bolzano; Ospedale di Careggi, Firenze; Ospedale Civile, Ravenna; Ospedale V. Cervello, Palermo; Hospital Casa Sollievo, San Giovanni Rotondo; Universita di Modena, Modena; Istituto Nazionale Tumori, Milano; Universita di Verona, Verona; Universita'degli Studi di Bari, Bari; Ospedale Bergamo, Bergamo; Universita di Udine, Udine; Universita Tor Vergata, Rome; Ospedale di Torrette, Ancona; Ospedale Oncologico, Cagliari. Netherlands: University Hospital, Utrecht; Daniel den Hoed Cancer Centre, Rotterdam; University Hospital St Radboud, Nijmegen; University Hospital Maastricht, Maastricth. Norway: The Norwegian Radium Hospital, Oslo. Portugal: Centro Porto, Porto. Spain: Hospital Clinic, Barcelona; Hospital de la Princesa, Madrid; Marqués de Valdecilla, Santander; Hospital Santa Creu i Sant Pau, Barcelona; Hospital Universitario ‘La Fé’, Valencia; Hospital Clinico, Salamanca; Hospital Duran i Reynals, Barcelona; Hospital Universitario ‘Virgen delR, Sevilla. Sweden: Huddinge University, Huddinge; University Hospital, Uppsala; University Hospital, Lund; Sahlgrenska University, Goeteborg. Switzerland: University Hospital, Zurich. United Kingdom: Royal Free Hospital, London; Royal Marsden Hospital, Sutton; University College London Hospital, London; Western General Hospital, Edinburgh; Glasgow Royal Infirmary, Glasgow; Newcastle General Hospital, Newcastle upon Tyne; Heartlands Hospital, Birmingham; Department of Haematology, Liverpool; Addenbrookes Hospital, Cambridge; University of Southampton, Southampton; City Hospital, Nottingham; Guy's Hospital, London; City Hospital, Belfast; St Bartholomews Hospital, London; Christie NHS Trust Hospital, Manchester.

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  1. Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, UK

    A J Peniket, M C Ruiz de Elvira, G Taghipour, C Cordonnier, E Gluckman, T de Witte, G Santini, D Blaise, H Greinix, A Ferrant, J Cornelissen, N Schmitz & A H Goldstone

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Peniket, A., Ruiz de Elvira, M., Taghipour, G. et al. An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation. Bone Marrow Transplant 31, 667–678 (2003). https://doi.org/10.1038/sj.bmt.1703891

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