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Oct 4, 2007 - diseases included CLL with Richter's transformation, Hodgkin disease (HD) with the exception of nodular lymphocyte–predominant subtype, ...

From bloodjournal.hematologylibrary.org by guest on June 4, 2013. For personal use only.

Prepublished online October 4, 2007; doi:10.1182/blood-2007-07-098483

Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia Mohamed L Sorror, Barry E Storer, David G. Maloney, Brenda M. Sandmaier, Paul J. Martin and Rainer Storb

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From bloodjournal.hematologylibrary.org by guest on June 4, 2013. For personal use only.

Blood First Edition Paper, prepublished online October 4, 2007; DOI 10.1182/blood-2007-07-098483

Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia

Mohamed L. Sorror1, Barry E. Storer1,2, David G. Maloney1,2, Brenda M. Sandmaier1,2, Paul J. Martin1,2, and Rainer Storb1,2 Fred Hutchinson Cancer Research Center and the 2Department of Medicine at University of

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Washington School of Medicine, Seattle, WA.

Supported in part by grants CA78902, CA18029, CA15704, and HL088021 from the National Institutes of Health, Bethesda, MD and in part by the Paros Family Fund. Correspondence and reprints to: Mohamed Sorror, M.D., Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., D1-100, P.O. Box 19024, Seattle, WA 98109-1024, Telephone: (206) 667-2765, FAX: (206) 667-6124, e-mail: [email protected] Short title: Allogeneic transplant, lymphoma, CLL, comorbidity

Key Words: Hematopoietic cell transplantation; non-Hodgkin lymphoma; Hodgkin lymphoma; and chronic lymphocytic leukemia; nonmyeloablative conditioning; myeloablative conditioning; and hematopoietic cell transplantation-specific comorbidity index.

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Copyright © 2007 American Society of Hematology

From bloodjournal.hematologylibrary.org by guest on June 4, 2013. For personal use only.

ABSTRACT

Allogeneic conventional hematopoietic cell transplantation (HCT) can be curative treatment for lymphoid malignancies, but it has been characterized by high non-relapse mortality (NRM). Here, we compared outcomes among patients with lymphoma or chronic lymphocytic leukemia given either nonmyeloablative (n=152) or myeloablative (n=68) conditioning. Outcomes were stratified by the HCT-specific comorbidity index. Patients in the nonmyeloablative group were older, had more prior treatment and more comorbidities, more frequently had unrelated donors, and more often had malignancy in remission compared to patients in the myeloablative group. Patients with indolent versus aggressive malignancies were equally distributed among both cohorts. After HCT, patients without comorbidities both in the nonmyeloablative and myeloablative cohorts had comparable NRM (p=0.74), overall survival (p=0.75) and progression-free survival (p=0.40). No significant differences were observed (p=0.91, p=0.89, and p=0.40, respectively) after adjustment for pretransplant variables. Patients with comorbidities experienced lower NRM (p=0.009) and better survival (p=0.04) after nonmyeloablative conditioning. These differences became more significant (p