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Autografting

Prognostic value of comorbidity for auto-SCT eligibility and outcome in relapsed or refractory aggressive non-Hodgkin's lymphoma

Bone Marrow Transplantation volume 46, pages 827–834 (2011)Cite this article

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Abstract

Salvage reinduction therapy followed by high-dose chemotherapy (HDCT) and auto-SCT is the treatment of choice for fit patients with refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL). We assessed the prognostic value of comorbidity at the time of relapse to predict receipt of auto-SCT and outcome. We analyzed 156 consecutive NHL patients, referred to our center between 1999 and 2007 for salvage reinduction therapy, followed by HDCT and auto-SCT. Comorbidity according to the hematopoietic SCT comorbidity index was scored at relapse and directly before HDCT and auto-SCT. Primary end points were actual receipt of auto-SCT and survival. At relapse, comorbidity scores of 0, 1–2 and ⩾3 were found among 64 (41%), 62 (40%) and 30 (19%) patients, respectively. Ultimately, 95 patients received auto-SCT. Higher comorbidity scores at relapse were associated with significantly less chance of receiving auto-SCT and with inferior OS, independently from secondary age-adjusted International Prognostic Index (sAAIPI) scores. For transplanted patients, OS rates at 5 years were 62, 30 and 17% for relapse comorbidity scores of 0, 1–2 and ⩾3, respectively. In patients with relapsed NHL, comorbidity at relapse is associated with receipt of auto-SCT and subsequent survival independently from the sAAIPI.

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References

  1. Pfreundschuh M, Trumper L, Osterborg A, Pettengell R, Trneny M, Imrie K et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006; 7: 379–391.

    Article  CAS  PubMed  Google Scholar 

  2. Sehn LH, Donaldson J, Chhanabhai M, Fitzgerald C, Gill K, Klasa R et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 2005; 23: 5027–5033.

    Article  CAS  PubMed  Google Scholar 

  3. Couderc B, Dujols JP, Mokhtari F, Norkowski JL, Slawinski JC, Schlaifer D . The management of adult aggressive non-Hodgkin's lymphomas. Crit Rev Oncol Hematol 2000; 35: 33–48.

    Article  CAS  PubMed  Google Scholar 

  4. Philip T, Biron P . High-dose chemotherapy and autologous bone marrow transplantation in diffuse intermediate- and high-grade non-Hodgkin lymphoma. Crit Rev Oncol Hematol 2002; 41: 213–223.

    Article  PubMed  Google Scholar 

  5. Shipp MA, Abeloff MD, Antman KH, Carroll G, Hagenbeek A, Loeffler M et al. International consensus conference on high-dose therapy with hematopoietic stem-cell transplantation in aggressive non-Hodgkin's lymphomas: report of the jury. Ann Oncol 1999; 10: 13–19.

    Article  CAS  PubMed  Google Scholar 

  6. A Predictive Model for Aggressive Non-Hodgkin's Lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993; 329: 987–994.

    Article  Google Scholar 

  7. Moskowitz CH, Nimer SD, Glassman JR, Portlock CS, Yahalom J, Straus DJ et al. The International Prognostic Index predicts for outcome following autologous stem cell transplantation in patients with relapsed and primary refractory intermediate-grade lymphoma. Bone Marrow Transplant 1999; 23: 561–567.

    Article  CAS  PubMed  Google Scholar 

  8. Hamlin PA, Zelenetz AD, Kewalramani T, Qin J, Satagopan JM, Verbel D et al. Age-adjusted international prognostic index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood 2003; 102: 1989–1996.

    Article  CAS  PubMed  Google Scholar 

  9. Blay J, Gomez F, Sebban C, Bachelot T, Biron P, Guglielmi C et al. The international prognostic index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Parma Group. Blood 1998; 92: 3562–3568.

    CAS  PubMed  Google Scholar 

  10. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sorror ML, Giralt S, Sandmaier BM, De LM, Shahjahan M, Maloney DG et al. Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 2007; 110: 4606–4613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sorror ML, Storer BE, Maloney DG, Sandmaier BM, Martin PJ, Storb R . Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood 2008; 111: 446–452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hosing C, Saliba RM, Okoroji GJ, Popat U, Couriel D, Ali T et al. High-dose chemotherapy and autologous hematopoietic progenitor cell transplantation for non-Hodgkin's lymphoma in patients >65 years of age. Ann Oncol 2008; 19: 1166–1171.

    Article  CAS  PubMed  Google Scholar 

  14. Wildes TM, Augustin KM, Sempek D, Zhang QJ, Vij R, Dipersio JF et al. Comorbidities, not age, impact outcomes in autologous stem cell transplant for relapsed non-Hodgkin lymphoma. Biol Blood Marrow Transplant 2008; 14: 840–846.

    Article  CAS  PubMed  Google Scholar 

  15. Sorror M, Storer B, Gopal A, Homberg L, Sandmaier BM, Bensinger WI et al. Comorbidity, lactate dehydrogenase (LDH), and chemosensitivity are independent predictors of mortality after autologous hematopoietic cell transplantation (HCT) for patients (pts) with lymphoma. ASH Annu Meet Abstr 2007; 110: 616.

    Google Scholar 

  16. Jantunen E, Itala M, Siitonen T, Koivunen E, Leppa S, Juvonen E et al. Late non-relapse mortality among adult autologous stem cell transplant recipients: a nation-wide analysis of 1,482 patients transplanted in 1990–2003. Eur J Haematol 2006; 77: 114–119.

    Article  CAS  PubMed  Google Scholar 

  17. Buadi FK, Micallef IN, Ansell SM, Porrata LF, Dispenzieri A, Elliot MA et al. Autologous hematopoietic stem cell transplantation for older patients with relapsed non-Hodgkin's lymphoma. Bone Marrow Transplant 2006; 37: 1017–1022.

    Article  CAS  PubMed  Google Scholar 

  18. Kim SW, Tanimoto TE, Hirabayashi N, Goto S, Kami M, Yoshioka S et al. Myeloablative allogeneic hematopoietic stem cell transplantation for non-Hodgkin lymphoma: a nationwide survey in Japan. Blood 2006; 108: 382–389.

    Article  CAS  PubMed  Google Scholar 

  19. Vellenga E, van Putten WL, van ‘t Veer MB, Zijlstra JM, Fibbe WE, van Oers MH et al. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: a prospective randomized HOVON trial. Blood 2008; 111: 537–543.

    Article  CAS  PubMed  Google Scholar 

  20. Cheson BD . The International Harmonization Project for response criteria in lymphoma clinical trials. Hematol Oncol Clin North Am 2007; 21: 841–854.

    Article  PubMed  Google Scholar 

  21. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244–1253.

    Article  CAS  PubMed  Google Scholar 

  22. Artz AS, Pollyea DA, Kocherginsky M, Stock W, Rich E, Odenike O et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12: 954–964.

    Article  PubMed  Google Scholar 

  23. Sorror M, Storer B, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al. Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008; 112: 1992–2001.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    W J Plattel, H C Kluin-Nelemans & G W van Imhoff

  2. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    G H de Bock

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  1. W J Plattel
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  2. H C Kluin-Nelemans
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  3. G H de Bock
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Correspondence to W J Plattel.

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Plattel, W., Kluin-Nelemans, H., de Bock, G. et al. Prognostic value of comorbidity for auto-SCT eligibility and outcome in relapsed or refractory aggressive non-Hodgkin's lymphoma. Bone Marrow Transplant 46, 827–834 (2011). https://doi.org/10.1038/bmt.2010.188

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