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Efficacy of High-Dose Therapy and Autologous Hematopoietic Cell Transplantation in Gray Zone Lymphoma: a US Multicenter Collaborative Study
Kharfan-Dabaja, M. A., Raj, R., Nikolaenko, L., Ahmed, S., Reddy, N., Nathan, S., Cherry, M., El-Jurdi, N., Obiozor, C., Fenske, T. S., et al
Biology of Blood & Marrow Transplantation. 2017
Abstract
High-dose therapy (HDT) and autologous hematopoietic cell transplantation (auto-HCT) has been anecdotally prescribed in gray zone lymphoma (GZL), showing encouraging efficacy. We conducted a multicenter retrospective study aimed to assess outcomes after auto-HCT in 32 patients with GZL treated at 9 transplant centers in the United States. Median age of patients at transplantation was 38 (18-70) years and the majority were male (n=21, 66%). Median number of lines of therapy prior to transplantation was 2 (1-4). BEAM was the most commonly prescribed regimen (n=23, 72%). Median follow up for surviving patients was 34 (1-106) months. Median OS was not reached. The 3-year PFS and OS for all patients were 69% and 78%, respectively. Three-year PFS and OS was 100% for patients who received only 1 line of therapy prior to auto-HCT vs. 65% (PFS, p=0.25) and 75% (OS, p=0.39) for those receiving >1 line. Cumulative incidence of relapse/progression at 1-year and 3-year post-transplantation were 4% and 31%, respectively. The 3-year NRM was 0. These findings suggest that HDT and auto-HCT is an effective treatment in patients with GZL. Our findings would ideally require confirmation in a larger cohort of patients, preferably in the setting of large prospective multicenter RCTs. However, we acknowledge that such studies could be hard and improbable to conduct in GZL owing to its rarity. Alternatively, a multicenter prospective study, which includes tissue banking and a data registry, to help better understand the biology and natural history of the disease is warranted.