Superiority of Allogeneic to Autologous Marrow or Blood Stem Cell Transplantation for Low-Grade Lymphoma
Several published reports have suggested that although there is a lesser relapse rate for allogeneic bone marrow transplantation (BMT) compared to autologous BMT in patients with low-grade lymphoma, no survival advantage was evident because of higher toxicity associated with allogeneic BMT. To address this issue, we compared outcome in 38 patients with low-grade lymphoma who received allogeneic BMT to 72 patients who underwent autologous BMT at our institution.
Several published reports have suggested that although there is a lesser relapse rate for allogeneic bone marrow transplantation (BMT) compared to autologous BMT in patients with low-grade lymphoma, no survival advantage was evident because of higher toxicity associated with allogeneic BMT. To address this issue, we compared outcome in 38 patients with low-grade lymphoma who received allogeneic BMT to 72 patients who underwent autologous BMT at our institution.
The allogeneic BMT group was younger (median age, 40.5 vs 47 years; P = .001) but included more patients with refractory disease (58% vs 22%; P < .0001). The median number of prior chemotherapy regimen was two in the allogeneic group and three in the autologous group (P = NS). In the autologous BMT group, 36% of patients had marrow involvement, compared to 60% in the allogeneic BMT group.
The preparative regimen used was cyclophosphamide (Cytoxan, Neosar)/etoposide/total-body irradiation for patients in the autologous BMT group and for 22 patients (58%) in the allogeneic BMT group. The remaining allogeneic BMT patients received BEAM (BCNU, etoposide, ara-C, and melphalan).
The overall survival (OS) rates were 55% vs 35% (P = .007) and event-free survival (EFS) rates were 44% vs 15% (P = .01) in favor of allogeneic BMT. The relapse rates at 3 years in the allogeneic BMT and autologous BMT groups were 25% and 64%, respectively (P = .08).
We compared various parameters for survival and EFS: disease status (sensitive vs refractory), age, preparative regimen used, prior number of chemotherapy regimens received, beta-2-microglobulin, lactic dehydrogenase (LDH) level, and histology. Autologous BMT patients did not show an advantage in any of these categories.
On univariate analysis, there was a survival advantage for allogeneic BMT compared to autologous BMT if there was bone marrow involvement (P = .003), if patients had three or fewer chemotherapy regimens (P = .007), low beta-2-microglobulin of £ 2 (P = .019), and normal LDH (P = .003).
On multivariate analysis that also included age, patients with allogeneic BMT had a survival advantage if they were < 40 years old (P = .007) and had beta-2-microglobulin £ 2 (P = .008). Only beta-2-microglobulin of £ 2 appeared to be significant for EFS (P = .03).
CONCLUSION: The data indicate a better outcome for allogeneic BMT vs autologous BMT for low-grade lymphoma, at a single institution. This advantage is most significant for younger patients with a low tumor burden.
Click here for Dr. Bruce Chesons commentary on this abstract.
