Impact of Conditioning Regimen on Outcomes for Patients with Lymphoma Undergoing High-Dose Therapy with Autologous Hematopoietic Cell Transplantation

Yi Bin Chen, Andrew A. Lane, Brent R. Logan, Xiaochun Zhu, Görgün Akpek, Mahmoud D. Aljurf, Andrew S. Artz, Christopher N. Bredeson, Kenneth R. Cooke, Vincent T. Ho, Hillard M. Lazarus, Richard F. Olsson, Wael Saber, Philip L. McCarthy, Marcelo C. Pasquini

Research output: Contribution to journalArticlepeer-review

Abstract

There are limited data to guide the choice of high-dose therapy (HDT) regimen before autologous hematopoietic cell transplantation (AHCT) for patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). We studied 4917 patients (NHL, n = 3905; HL, n = 1012) who underwent AHCT from 1995 to 2008 using the most common HDT platforms: carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) (n = 1730); cyclophosphamide, BCNU, and etoposide (CBV) (n = 1853); busulfan and cyclophosphamide (BuCy) (n = 789); and total body irradiation (TBI)-containing treatment (n = 545). CBV was divided into CBVhigh and CBVlow based on BCNU dose. We analyzed the impact of regimen on development of idiopathic pulmonary syndrome (IPS), transplantation-related mortality (TRM), and progression-free and overall survival. The 1-year incidence of IPS was 3% to 6% and was highest in recipients of CBVhigh (hazard ratio [HR], 1.9) and TBI (HR, 2.0) compared with BEAM. One-year TRM was 4% to 8%, respectively, and was similar between regimens. Among patients with NHL, there was a significant interaction between histology, HDT regimen, and outcome. Compared with BEAM, CBVlow (HR, .63) was associated with lower mortality in follicular lymphoma (P < .001), and CBVhigh (HR, 1.44) was associated with higher mortality in diffuse large B cell lymphoma (P = .001). For patients with HL, CBVhigh (HR, 1.54), CBVlow (HR, 1.53), BuCy (HR, 1.77), and TBI (HR, 3.39) were associated with higher mortality compared with BEAM (P < .001). The impact of specific AHCT regimen on post-transplantation survival is different depending on histology; therefore, further studies are required to define the best regimen for specific diseases.

Original languageEnglish (US)
Pages (from-to)1046-1053
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number6
DOIs
StatePublished - Jun 2015

Keywords

  • Autologous transplantation
  • Idiopathic pneumonia syndrome
  • Lymphoma

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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