OBJECTIVE: This study analyzes the effect of interventions aimed at reinducing remissions in patients with relapse or progression of malignant disease following allogeneic hematopoietic cell transplantation (HCT) using nonmyeloablative conditioning. METHODS: We performed a retrospective analysis of 81 instances of relapse or progression occurring among 224 patients given HCT as treatment of their hematologic malignancies. All patients received conditioning with 2 Gy total-body irradiation with or without fludarabine and with postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. RESULTS: Overall survival of patients after relapse or progression was 36%. Fifteen of the 81 patients were given no interventions. Three of these 15 (20%) patients are alive with disease while 12 died with disease progression. Sixty-six patients (81%) received interventions, including withdrawal of immunosuppression (n=32), donor lymphocyte infusions (n=13), or chemotherapy (n=21). Twenty of the 66 (30%) are alive, 5 in complete remission, 4 in partial remission, 1 with stable and 10 with progressive disease. The overall response rate to intervention was 27%. Forty-six (70%) of the patients given interventions died, mainly due to relapse/progression. Patients not receiving interventions had a 1-year survival estimate of 15% compared to 41% in patients given interventions. Factors associated with survival in patients given intervention were disease response (p=0.002), disease category (p=0.001), and time to relapse from transplantation (p=0.0005). CONCLUSIONS: While the overall prognosis of patients relapsing or progressing after nonmyeloablative HCT is poor, interventions such as the combined use of immunotherapy and chemotherapy can improve patient survival.
OBJECTIVE: This study analyzes the effect of interventions aimed at reinducing remissions in patients with relapse or progression of malignant disease following allogeneic hematopoietic cell transplantation (HCT) using nonmyeloablative conditioning. METHODS: We performed a retrospective analysis of 81 instances of relapse or progression occurring among 224 patients given HCT as treatment of their hematologic malignancies. All patients received conditioning with 2 Gy total-body irradiation with or without fludarabine and with postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. RESULTS: Overall survival of patients after relapse or progression was 36%. Fifteen of the 81 patients were given no interventions. Three of these 15 (20%) patients are alive with disease while 12 died with disease progression. Sixty-six patients (81%) received interventions, including withdrawal of immunosuppression (n=32), donor lymphocyte infusions (n=13), or chemotherapy (n=21). Twenty of the 66 (30%) are alive, 5 in complete remission, 4 in partial remission, 1 with stable and 10 with progressive disease. The overall response rate to intervention was 27%. Forty-six (70%) of the patients given interventions died, mainly due to relapse/progression. Patients not receiving interventions had a 1-year survival estimate of 15% compared to 41% in patients given interventions. Factors associated with survival in patients given intervention were disease response (p=0.002), disease category (p=0.001), and time to relapse from transplantation (p=0.0005). CONCLUSIONS: While the overall prognosis of patients relapsing or progressing after nonmyeloablative HCT is poor, interventions such as the combined use of immunotherapy and chemotherapy can improve patient survival.
Authors: A M Willasch; E Salzmann-Manrique; T Krenn; M Duerken; J Faber; J Opper; H Kreyenberg; R Bager; S Huenecke; C Cappel; M Bremm; V Pfirrmann; M Merker; E Ullrich; S Bakhtiar; E Rettinger; A Jarisch; J Soerensen; T E Klingebiel; P Bader Journal: Bone Marrow Transplant Date: 2016-09-19 Impact factor: 5.483
Authors: Ron Ram; Ted A Gooley; David G Maloney; Oliver W Press; John M Pagel; Stephen H Petersdorf; Andrei R Shustov; Mary E D Flowers; Paul O'Donnell; Brenda M Sandmaier; Rainer F Storb; Ajay K Gopal Journal: Biol Blood Marrow Transplant Date: 2011-04-12 Impact factor: 5.742
Authors: Marcel R M van den Brink; David L Porter; Sergio Giralt; Sydney X Lu; Robert R Jenq; Alan Hanash; Michael R Bishop Journal: Biol Blood Marrow Transplant Date: 2009-10-24 Impact factor: 5.742
Authors: Ran Reshef; Elizabeth O Hexner; Alison W Loren; Noelle V Frey; Edward A Stadtmauer; Selina M Luger; James K Mangan; Saar I Gill; Pavel Vassilev; Kathryn A Lafferty; Jacqueline Smith; Vivianna M Van Deerlin; Rosemarie Mick; David L Porter Journal: Biol Blood Marrow Transplant Date: 2014-07-10 Impact factor: 5.742