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NHL Transplant OutcomesFor some people with non-Hodgkin's lymphoma (NHL), a bone marrow or cord blood transplant (also called a BMT) may offer the best chance for long-term remission of their disease. This page provides some data on patients' outcomes after a transplant to treat NHL. For a more complete overview of NHL and how it may be treated, see Non-Hodgkin's Lymphoma (NHL).On this page:It is a good idea to ask your doctor for help interpreting these data and any other survival outcomes data you find. Your doctor can provide context for these data and discuss your specific situation with you. For more things to consider, see Understanding Survival Outcomes Data. Outcomes for autologous transplantsAn autologous transplant uses blood-forming cells collected from the patient. The cells are usually collected after the disease has been brought into remission. After treatment with high-dose chemotherapy and sometimes radiation therapy and/or immunotherapy, the patient receives his or her own cells back. The high-dose treatment is more intense than can be given without a transplant, so it may be able to destroy more cancer cells. Autologous transplant outcomes for patients with diffuse large B-cell lymphoma or follicular lymphoma are shown in Figures 1 and 2.Figure 1. Figure 2. Factors affecting outcomes of autologous transplantsThe status of the disease at the time of transplant can affect transplant outcomes. For both diffuse large cell lymphoma and follicular NHL, an autologous transplant in first remission may offer the best chance for long-term survival. Whether an autologous transplant is recommended at first remission depends on the type of lymphoma and a patient's specific risk factors.Figures 1 and 2 show that how well the disease responds to chemotherapy also affect chances of longterm survival.  Outcomes for allogeneic transplantsAn allogeneic transplant uses blood-forming cells from a family member or an unrelated donor or cord blood unit. Figures 3 and 4 below show the outcomes of transplants using matched sibling donors. Figure 5 shows outcomes of unrelated donor transplants facilitated by the National Marrow Donor Program (NMDP).For allogeneic transplants using adult donors, the blood-forming cells can be collected from the donor’s marrow or from the bloodstream (peripheral blood stem cells, or PBSC). Figure 5 compares marrow and PBSC, and shows no significant difference in outcomes. Doctors are still trying to find out whether one works better than the other. A large clinical trial comparing marrow and PBSC is now in progress. Figure 3. Figure 4. Figure 5.
Effect of donor match on allogeneic transplant outcomesA patient's chances of a good outcome after an allogeneic transplant can be affected by the closeness of the donor match. In general, a closely matched sibling donor gives a better chance of survival than an unrelated donor.Effect of reduced-intensity transplants on outcomesAn allogeneic transplant has risks of serious side effects and complications. Many of these are caused by the transplant preparative regimen of high-dose chemotherapy and sometimes radiation therapy and/or immunotherapy. However, people who are older or have other health problems, such as heart disease or organ damage from previous chemotherapy, may be unable to tolerate a high-dose preparative regimen. A reduced-intensity transplant, which uses a less intense preparative regimen, may be an option for some of these patients, including patients who have relapsed after an autologous transplant.Figures 3 and 4 above show compare results for reduced-intensity (labeled RIC) and high-dose (myeloablative) preparative regimens. NMDP data for unrelated donor transplants (Figure 5) show outcomes for reduced-intensity (non-myeloablative) transplants. Studies have shown that patients may have fewer early complications after reduced-intensity transplants. [1, 2] However, some complications like graft-versus-host disease and infection are still common. For patients treated for NHL, early results were similar to or better than those seen after high-dose allogeneic transplants.
Longer follow-up will provide more information about how long-term survival rates after reduced-intensity transplant compare to those after high-dose transplant. Clinical studies are ongoing to better determine the role of reduced-intensity transplant in treating NHL. Comparing outcomes of autologous and allogeneic transplantsAutologous transplant is used more often than allogeneic transplant to treat NHL. An important reason for this choice is the higher rate of life-threatening complications after allogeneic transplants. This risk has balanced or outweighed the higher risk of relapse after an autologous transplant, leading to survival rates that are similar or higher for autologous transplants. [3, 4]For example, in a study of 904 patients who received a transplant for follicular lymphoma between 1990 and 1999 at multiple transplant centers, 176 patients received allogeneic transplants using sibling donors and the others received autologous transplants. [4]
However, with advances in transplant, outcomes for allogeneic transplant have improved in the last decade. This study showed that the likelihood of 3-year survival was about 30% higher for patients who received allogeneic transplants between 1997 and 1999 than for those who received transplants between 1990 and 1993. [4] Making treatment choicesFor more information about non-Hodgkin's lymphoma treatment options and things to think about when making treatment choices, see Non-Hodgkin's Lymphoma — Making Treatment Decisions.References
Contributing editorsJames O. Armitage, M.D., University of Nebraska Medical Center, Omaha, Neb.C. F. LeMaistre, M.D., Southwest Texas Methodist Hospital, San Antonio, Texas |
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