Acute Leukemias - Republican Scientific Medical Library

210 Chapter 16 · Treatment of Lymphoblastic Lymphoma in Adults
Table 16.4. Results of SCT in lymphoblastic lymphoma
Author
Auto CR1
Year N DFS
Milpied, et al. [45] 1989 13 68% a
Baro, et al. [46] 1992 14 77%
Morel, et al. [14] 1992 5 60% b
Bouabdallah, et al. [16] 1998 16 62% b
Verdonck, et al. [47] 1992 9 67% b
Santini, et al. [13] 1991 21 66%
Sweetenham, et al. [48] 1994 105 63% c
Jost, et al. [42] 1995 17 31% d
Zinzani, et al. [15] 1996 10 70% b
Conde, et al. [49] 1999 58 76%
Sweetenham,et al.[50] 2001 31 55%
Song, et al. [34] 2007 25 69%
Total
Auto > CR1
241 61
(31–77)%
Baro, et al. [46] 1992 8 50%
Morel, et al. [14] 1992 7 43% b
Conde, et al. [49] 1999 11 36%
Total
Allo CR1
15 47
(43–50)%
Milpied, et al. [45] 1989 12 68% a
Bouabdallah,et al. [16] 1998 11 91% b
Sweetenham,
et al. [50]
2001 7 59%
Total 30 74
(59–91)%
Allo > CR1
Morel, et al. [14] 1992 7 14% b
Van Besien, et al. [51] 1996 25 17%
Total 32 16
(14–17)%
According to [11]
a
for allo and auto together; no difference observed
b
percentage, not probability
c
overall survival
d
including Burkitt’s lymphoma
study the lower relapse rate after allo SCT was outweighed
by higher mortality [53].
16.8.3 Auto Versus Allo SCT
In several reports, results of auto and allo SCT were
compared. Milpied, et al. reported a series of 25 patients
with stage III-IV LBL. The LFS was 68% with no difference
between allo and auto SCT [45]. Another group reported
results of allo SCT in LBL which was performed
in younger patients with advanced disease. Ten out of 12
patients mainly transplanted in CR1 survived disease
free. LFS after allo SCT was superior (78%) to auto
SCT (50%) in this study [16].
Results of SCT (auto N = 128; allo N = 76) in 204
LBL patients at different stages of disease are available
from an analysis performed by the International Bone
Marrow Transplantation Registry (IBMTR) and the
Autologous Blood and Marrow Transplantation Registry
(ABMTR). Not surprisingly, there was a higher TRM
after allo (18%) compared to auto (3%) SCT. On the
other hand, the authors observed a lower relapse rate
of 34% for allo compared to 56% for auto SCT after longer
observation time. Altogether there was no difference
of survival at 5 years with 44% for auto and 39% for allo
SCT. Prognostic factors for DFS were donor source, BM
involvement, and disease stage [54]. As these are registry
data, the options for interpretation are limited. The
overall result is not superior to chemotherapy, but includes
patients with advanced disease. The risk profile
of the patients and the effects of previous therapy, which
may be particularly important for auto SCT, are not
analyzed. However, there seems to be a graft-versuslymphoma
effect in LBL. Since TRM may be lowered
in more recent trials, allo SCT could be an option for
high-risk T-LBL. In patients after relapse allo SCT
should probably be preferred to auto SCT in patients
with an available donor.
16.8.4 Auto SCT Versus Chemotherapy
In the largest prospective trial with randomized comparison
of auto SCT and conventional consolidation/maintenance,
however, only 65 of 98 eligible patients were actually
randomized. The DFS for conventional chemotherapy
was 24% compared to 55% for auto SCT.
No difference was detected for survival (45 vs. 56%).