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The impact of allogeneic hematopoietic cell transplantation on the mortality of poor-risk non-Hodgkin lymphoma: an intent-to-transplant analysis

Bone Marrow Transplantation volume 56, pages 30–37 (2021)Cite this article

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Abstract

Purpose of this single-centre retrospective study was to assess the outcome of allogeneic hematopoietic cell transplantation (alloHCT) for relapsed/refractory (r/r) non-Hodgkin lymphoma (NHL) by intent-to-transplant (ITT). Included were all consecutive patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and peripheral T-cell lymphoma (PTCL) for whom a donor search was performed between 2004 and 2018. Primary endpoint was overall survival (OS) measured from search initiation. A donor search was initiated for 189 patients (DLBCL 61, FL 32, MCL 43, and PTCL 53), with 76% of the patients having active disease. OS at 5 years after search initiation for DLBCL, FL, MCL, and PTCL was 26%, 44%, 52%, and 50%, respectively. AlloHCT was performed in 137 patients (72%; DLBCL 64%). Main reason for not undergoing alloHCT was disease progression, whereas donor unavailability accounted for only 4% of pretransplantation failures. These results suggest that survival of patients with r/r NHL entering the alloHCT route may be overestimated by a factor of 1.2–1.4 if based on actually transplanted patients only. This effect should be taken into account when using alloHCT as benchmark for new therapeutic approaches for the treatment of poor-risk NHL.

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Fig. 1: Overall survival from search indication by entity.
Fig. 2: Overall survival from 3-month landmark after search indication.

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  1. Department Medicine V, University of Heidelberg, Heidelberg, Germany

    Lorenz Selberg, Peter Stadtherr, Sascha Dietrich, Thomas Luft, Ute Hegenbart, Andrea Bondong, Julia Meissner, Nora Liebers, Michael Schmitt, Anthony Dick Ho, Carsten Müller-Tidow & Peter Dreger

  2. Institute of Immunology, University of Heidelberg, Heidelberg, Germany

    T. Hien Tran

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LS and PD designed the concept and wrote the manuscript. All other authors contributed to further development of the concept, helped writing the manuscript, and approved the final version of the manuscript.

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Correspondence to Peter Dreger.

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PD: consultancy for AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, Roche; speakers bureau for AbbVie, Gilead, Novartis, Riemser, Roche; research support from Neovii and Riemser. MS: research grants from Apogenix, Hexal and Novartis. Travel grants from Hexal and Kite. Financial support for educational activities and conferences from bluebird bio, Kite, and Novartis. Advisory board member of MSD. (Co-)PI of clinical trials of MSD, GSK, Kite, and BMS. Co-Founder and shareholder of TolerogenixX Ltd. LS, PS, SD, THT, TL, UH, JM, AB, NL, ADH, CMT: none.

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Selberg, L., Stadtherr, P., Dietrich, S. et al. The impact of allogeneic hematopoietic cell transplantation on the mortality of poor-risk non-Hodgkin lymphoma: an intent-to-transplant analysis. Bone Marrow Transplant 56, 30–37 (2021). https://doi.org/10.1038/s41409-020-0976-4

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