1. Allogeneic Transplantation for Relapsed Waldenström Macroglobulinemia and Lymphoplasmacytic Lymphoma
- Author
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Hillard M. Lazarus, Mehdi Hamadani, Rammurti T. Kamble, Anita D'Souza, Tomer M Mark, Parameswaran Hari, Yago Nieto, Siddhartha Ganguly, Gerhard C. Hildebrandt, Saad Z. Usmani, Robert F. Cornell, Tamila L. Kindwall-Keller, Ayman Saad, Richard F. Olsson, Jean Yared, Mohamed A. Kharfan-Dabaja, Edward A. Copelan, Miguel Angel Diaz, Jiaxing Huang, A. Samer Al-Homsi, Michael Martens, Kwang Woo-Ahn, Cesar O. Freytes, Veronika Bachanova, David I. Marks, Robert Peter Gale, David H. Vesole, Saurabh Chhabra, and Taiga Nishihori
- Subjects
Adult ,medicine.medical_specialty ,Transplantation Conditioning ,Allogeneic transplantation ,Databases, Factual ,Lymphoma ,Graft vs Host Disease ,Disease ,Gastroenterology ,Article ,Time-to-Treatment ,Lymphoplasmacytic Lymphoma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Relapsed lymphoma ,Lymph node ,Aged ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Waldenstrom macroglobulinemia ,Hematology ,Middle Aged ,medicine.disease ,Survival Analysis ,Allogeneic stem cell transplant ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Bone marrow ,Waldenstrom Macroglobulinemia ,business ,Progressive disease ,030215 immunology - Abstract
Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) is characterized by lymphoplasmacytic proliferation, lymph node and spleen enlargement, bone marrow involvement, and immunoglobulin M production. Treatment varies based on the extent and biology of disease. In some patients, the use of allogeneic hematopoietic cell transplantation (alloHCT) may have curative potential. We evaluated long-term outcomes of 144 patients that received adult alloHCT for WM/LPL. Data was obtained from the Center for International Blood and Marrow Transplant Research database (2001-2013). Patients received myeloablative (n=67) or reduced intensity conditioning (RIC; n=67). Median age at alloHCT was 53 years, and median time from diagnosis to transplantation was 41 months. Thirteen percent (n=18) failed prior autologous hematopoietic cell transplantation. About half (n=82, 57%) had chemo-sensitive disease at the time of transplantation, while 22% had progressive disease. Progression free survival, overall survival, rate of relapse, and non-relapse mortality at 5-years were 46%, 52%, 24%, and 30% respectively. Patients with chemo-sensitive disease and better pre-transplant disease status experienced significantly superior overall survival. There were no significant differences in progression-free survival based on conditioning (myeloablative 50% vs. RIC 41%) or graft source. Conditioning intensity did not impact treatment-related mortality or relapse. The most common causes of death were primary disease and graft-versus-host disease (GVHD). AlloHCT yielded durable survival in select patients with WM/LPL. Strategies to reduce mortality from GVHD and post-transplant relapse are necessary to improve this approach.
- Published
- 2017
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