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Bone marrow transplantation  2014;50(2):197-203.
Alternative donor transplantation is increasingly used for high risk lymphoma patients. We analyzed 1593 transplant recipients (2000 to 2010) and compared transplant outcomes in recipients of 8/8 allele human leukocyte antigen (HLA)-A, -B, -C, and DRB1 matched unrelated donors (MUD; n=1176), 7/8 allele HLA-matched unrelated donors (MMUD; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared to MUD (35%; p=0.004), but similar to UCB recipients (37%; p=0.19), although UCB had lower rates of neutrophil and platelet recovery compared to unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, p=0.003) but similar between UCB and MUD (30% vs 33%; p=0.48). In multivariate analysis UCB recipients had lower risks of acute and chronic graft versus host disease compared with adult donor groups (UCB vs MUD: HR=0.68, p=0.05; HR=0.35; p<0.001). Adjusted 3-year overall survival was comparable (43% MUD, 37% MMUD and 41% UCB). Data highlight that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can expand the curative potential of allotransplant to patients who lack suitable HLA-matched sibling or MUD.
PMCID: PMC4336786  PMID: 25402415
Umbilical Cord Blood; Lymphoma; Alternative Donor Transplantation
2.  Outcomes of hematopoietic cell transplantation for diffuse large B cell lymphoma transformed from follicular lymphoma 
There are limited data on the outcomes of autologous or allogeneic hematopoietic cell transplantation in diffuse large B-cell lymphoma transformed from follicular lymphoma. We analyzed transplant outcomes in 141 subjects with biopsy-proven diffuse large B-cell lymphoma transformed from follicular lymphoma reported to the Center for International Blood and Marrow Transplant Research from 1990–2009. Two groups were identified: autotransplant (N=108) and allotransplant (N=33). Fewer autotransplants were done for transformed follicular lymphoma in 2003–2009, with a shift favoring allotransplants. Autotransplant had 1 year non-relapse mortality of 8% (95% confidence intervals [CI] 4–14), 5 year progression free survival of 35% (95% CI 26–45), and 5 year overall survival of 50% (95% CI 40–59). Allotransplant had 1 year non-relapse mortality of 41% (95% CI 23–58), 5 year progression free survival of 18% (95% CI 6–35), and 5 year overall survival of 22% (95% CI 8–41). Autotransplant for transformed follicular lymphoma achieves sustained remission in a high proportion of subjects. The high non-relapse mortality of allotransplant obscured any benefit that might be associated with this transplant modality.
PMCID: PMC4060436  PMID: 24641828
transformed follicular lymphoma; transplant
3.  Tolosa-Hunt Syndrome in Double-Hit Lymphoma 
Tolosa-Hunt syndrome (THS) is a painful condition characterized by hemicranial pain, retroorbital pain, loss of vision, oculomotor nerve paralysis, and sensory loss in distribution of ophthalmic and maxillary division of trigeminal nerve. Lymphomas rarely involve cavernous sinus and simulate Tolosa-Hunt syndrome. Here we present a first case of double-hit B cell lymphoma (DHL) relapsing and masquerading as Tolosa-Hunt syndrome. The neurological findings were explained by a lymphomatous infiltration of the right Gasserian ganglion which preceded systemic relapse. As part of this report, the diagnostic criteria for Tolosa-Hunt syndrome and double-hit lymphoma are reviewed and updated treatment recommendations are presented.
PMCID: PMC4396905  PMID: 25918657
British journal of haematology  2013;162(5):648-656.
Pre-existing central nervous system (CNS) involvement may influence referral for autologous haematopoietic cell transplantation (AHCT) for patients with non-Hodgkin lymphoma (NHL). The outcomes of 151 adult patients with NHL with prior secondary CNS involvement (CNS+) receiving an AHCT were compared to 4688 patients without prior CNS lymphoma (CNS−).
There were significant baseline differences between the cohorts. CNS+ patients were more likely to be younger, have lower performance scores, higher age-adjusted international prognostic index scores, more advanced disease stage at diagnosis, more aggressive histology, more sites of extranodal disease, and a shorter interval between diagnosis and AHCT. However, no statistically significant differences were identified between the two groups by analysis of progression-free survival (PFS) and overall survival (OS) at 5 years. A matched pair comparison of the CNS+ group with a subset of CNS− patients matched on propensity score also showed no differences in outcomes. Patients with active CNS lymphoma at the time of AHCT (n=55) had a higher relapse rate and diminished PFS and OS compared with patients whose CNS lymphoma was in remission (n=96) at the time of AHCT.
CNS+ patients can achieve excellent long-term outcomes with AHCT. Active CNS lymphoma at transplant confers a worse prognosis.
PMCID: PMC3766698  PMID: 23829536
CNS Involvement; Non-Hodgkin Lymphoma; Autologous transplantation; Outcomes
5.  Salvage Second Hematopoietic Cell Transplantation in Myeloma 
Autologous hematopoietic cell transplantation (AHCT) as initial therapy of patients with multiple myeloma (MM) improves survival. However, data to support this approach for relapsed/progressive disease after initial AHCT (AHCT1) are limited. Using Center for International Blood and Marrow Transplant Research data, we report the outcomes of 187 patients who underwent a second AHCT (AHCT2) for the treatment of relapsed/progressive MM. Planned tandem AHCT was excluded. Median age at AHCT2 was 59 years (range, 28 to 72), and median patient follow-up was 47 months (range, 3 to 97). Nonrelapse mortality after AHCT2 was 2% at 1 year and 4% at 3 years. Median interval from AHCT1 to relapse/progression was 18 months, and median interval between transplantations was 32 months. After AHCT2, the incidence of relapse/progression at 1 and 3 years was 51% and 82%, respectively. At 3 years after AHCT2, progression-free survival was 13%, and overall survival was 46%. In multivariate analyses, those relapsing ≥36 months after AHCT1 had superior progression-free (P = .045) and overall survival (P = .019). Patients who underwent AHCT2 after 2004 had superior survival (P = .026). AHCT2 is safe and feasible for disease progression after AHCT1. In this retrospective study, individuals relapsing ≥36 months from AHCT1 derived greater benefit from AHCT2 compared with those with a shorter disease-free interval. Storage of an adequate graft before AHCT1 will ensure that the option of a second autologous transplantation is retained for patients with relapsed/progressive MM.
PMCID: PMC3816739  PMID: 23298856
Second autologous; transplantation; Multiple myeloma; Relapsed multiple myeloma
6.  Hematopoietic Cell Transplantation for Primary Plasma Cell Leukemia: Results from the Center for International Blood and Marrow Transplant Research 
Leukemia  2011;26(5):1091-1097.
There is limited data on hematopoietic cell transplantation (HCT) in primary plasma cell leukemia (pPCL), an aggressive plasma cell disorder. We report outcomes of 147 patients with pPCL receiving autologous (n=97) or allogeneic (n=50) HCT within 18 months after diagnosis between 1995 and 2006. Median age was 56 years and 48 years for autologous HCT and allogeneic HCT respectively. Progression-free survival (PFS) at 3 years was 34% (95% CI, 23%-46%) in the autologous group and 20% (95% CI, 10%-34%) in the allogeneic group. Cumulative incidence of relapse at 3 years was 61% (95% CI, 48%-72%) in the autologous group and 38% (95% CI, 25%-53%) in the allogeneic group. Overall survival (OS) at 3 years was 64% (95% CI, 52%-75%) in the autologous group and 39% (95% CI, 26%-54%) in the allogeneic group. Non-relapse mortality (NRM) at 3 years was 5% (95% CI, 1-11%) in the autologous group and 41% (95% CI, 28%-56%) in the allogeneic group. The encouraging OS after autologous HCT, establishes the safety and feasibility of this consolidative treatment option after initial induction therapy for pPCL. Allogeneic HCT, although associated with a significantly lower relapse rate, carries a much higher risk of NRM and no overall survival benefit.
PMCID: PMC3274611  PMID: 22042147
primary plasma cell leukemia; stem cell transplant; overall survival
7.  MicroRNA Profiles of Drug-Resistant Myeloma Cell Lines 
Acta Haematologica  2010;123(4):201-204.
PMCID: PMC2881892  PMID: 20357429
Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens for diffuse large B-cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, many patients develop refractory or recurrent DLBCL and then receive autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes following AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n=176, “+R” group) or was not (n=818, “ −R” group) administered with front-line or salvage therapy prior to AuHCT. The +R group had superior progression-free survival (50% versus 38%, p=0.008) and overall survival (57% versus 45%, p=0.006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Non-relapse mortality (NRM) did not differ significantly between the +R and −R groups. In multivariate analysis, the +R group had improved progression-free survival (relative risk of relapse/progression or death 0.64, p<0.001) and improved overall survival (relative risk of death of 0.74, p=0.039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival following AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.
PMCID: PMC2913553  PMID: 19822306
autologous hematopoietic stem cell transplantation; lymphoma; rituximab

Results 1-8 (8)