The BMTinfonet group (www.bmtinfonet.org) shared a link to this paper on their Facebook page recently. It’s about the use of allo-stem cell transplant in the treatment of Diffuse Large B cell Lymphoma (DLBCL). The paper was written for scientific and medical professionals who are experts in this field. Even as a scientist with a biomedical background I found the paper difficult to read. The authors use a lot of acronyms and statistical analyses. If you are not a medical professional with a background in bone marrow transplantation, running clinical trials, and/or statistics, you would have a very difficult time plowing through this paper
In this article I will paraphrase the main points of the paper to make it easier to understand. I am not attempting to add anything to the original paper, or to claim any credit for the data, results, or conclusions presented. The original paper is available for purchase at the journal’s website, here:
I also have created a list of acronyms used in the paper, and their definitions, which I will post at the end of this article.
This paper describes a retrospective analysis of DLBCL patients that have received stem cell transplants from either siblings or matched unrelated donors. A retrospective study means it is a historical study. It looks back on, and combines data from, studies that were done in the past. The purpose of this study is to look back on data collected from DLBCL patients evaluated in other studies and see if allo-SCT is a viable treatment option for these patients.
In the summary, the authors say that data from 172 unrelated donor hematopoietic cell transplant (URD-HCT) recipients and 301 sib-HCT recipients are compared. This data was extracted from several previous clinical studies and combined. The median follow-up time for which data was available for all the patients was 45 months, or about 4 years. Results of the new data analyses show that the 3-year progression-free survival (PFS) rate was approximately 35% for both groups. Overall survival (OS) was 42% for the sib-HCT group and 37% for the URD group, but these numbers were not statistically different from one another (NS), meaning that no difference between the two groups was found.
The authors note that allo-HCT has only been used for patients that are not good candidates for auto-SCT. This could be because of factors such as extent of disease, resistance to chemotherapy, bone marrow involvement, or those who have failed a previous autograft. Allo-HCT tends to have lower relapse rates compared with auto-SCT, but has a greater risk of complications and mortality other than relapse (non-relapse mortality, NRM). Despite the history of shying away from allo-HCT as a treatment for DLBCL, its use has been on the rise recently due to use of reduced-intensity conditioning (RIC) and better unrelated donor selection.
The main conclusion from this study is that URD-HCT is just as good as sib-HCT for the treatment of DLBCL. This is an important finding because it provides an additional treatment option for patients that do not have a matched sibling available as a donor. This finding also provides doctors with a new opportunity to treat and possibly cure many patients who would not otherwise be considered for allo-HCT.
Avivi I, Canals C, Vernant J-P, Wulf G, Nagler A, Hermine O, Petersen E, Yakoub-Agha I, Craddock C, Schattenberg A, Niederwieser D, Thomson K, Blaise D, Attal M, Pfreundschuh M, Passweg J, Russell N, Dreger P and Sureda A, on behalf of the EBMT Lymphoma Working Party. 2014. Matched unrelated donor allogeneic transplantation provides comparable long-term outcome to HLA-identical sibling transplantation in relapsed diffuse large B-cell lymphoma. Bone Marrow Transplantation (2014), 1–8, advance online publication, 10 February 2014; doi:10.1038/bmt.2014.4.