Journal of Clinical Oncology, Vol 15, 1595-1600, Copyright © 1997 by American Society of Clinical Oncology
Role of a second transplant in the management of poor-prognosis lymphomas: a report from the European Blood and Bone Marrow Registry
E Vandenberghe, R Pearce, G Taghipour, L Fouillard and AH Goldstone
Department of Haematology, University College London Hospitals, United Kingdom. evandenb@hgmp.mrc.ac.uk
PURPOSE: Treatment of selected patients with poor-prognosis lymphomas with
high-dose chemotherapy and marrow or peripheral stem-cell rescue improves
prognosis. A second course of myeloablative chemotherapy has been given to
some patients, but few data are available on the indications, morbidity,
and overall survival associated with this approach. This study was
undertaken to evaluate morbidity and identify subgroups of patients who may
benefit from a second transplant. PATIENTS AND METHODS: Thirty-four
patients with lymphoma given two cycles of myeloablative chemotherapy and
entered onto the European Blood and Bone Marrow Transplant (EBMT) registry
between 1982 and 1995 were included in this study: Hodgkin's disease (HD),
n = 12; intermediate/high-grade non-Hodgkin's lymphoma (HG-NHL), n = 17;
and low-grade non-Hodgkin's lymphoma (LG-NHL), n = 5. The reason for second
transplant, status at transplant, conditioning regimen, morbidity, and both
progression-free survival (PFS) and overall survival (OS) were assessed.
RESULTS: The second procedure was performed for the following reasons: (1)
elective double procedure in four patients, (2) relapse after first
transplant in 20, (3) partial remission (PR) after first transplant in
eight, and (4) refractory disease after first transplant in two. The OS
rate at 2 years for patients who underwent two transplants (estimated from
the date of second transplant) was 49%, with a median follow-up time of 44
months. The OS rate at 2 years by histologic subtype was as follows; HD,
50%; HG-NHL, 60%; and LG-NHL, 0%. Seven of 15 patients with HD or HG-NHL
who relapsed after they had achieved a posttransplant complete remission
(CR) remain in CR 13 to 36 months after the second transplant, compared
with two of 10 patients in CR (at 6 and 19 months after second transplant)
who achieved a PR or had refractory disease after the first transplant.
There were eight deaths (24%) before 3 months, of which three (9%) were
transplant- related and the remainder due to persistent disease. Three late
toxic deaths occurred: two of cardiovascular disease and one of secondary
leukemia. CONCLUSION: Selected patients with HD and HG-NHL whose disease
recurs after one transplant may benefit from a second transplant. Patients
with refractory disease and LG-NHL did not benefit from a second
transplant.
