During the 10 years from 1992 to 2002, a total of 511 adult patients with diagnosis of lymphoma were transplanted in Turkey, 437 of whom were eligible for registry.
Patient characteristics for the entire group are shown in table 1. One-hundred and eighty-five patients were Hodgkin's lymphoma with a male to female ratio of 125/60. The median age of the patients was 23 years (range: 15-64). One-hundred and fifty-nine patients out of 185 were relapse cases and 26 out of 185 were primary refractory disease at the time of transplantation. Histopathologic subclassification were mixed cellular (48%), nodular sclerosing (25%), lymphocyte-predominant (13%), lym-phocyte-depleted (7%) and pathology unknown (7%).
Table 1: Characteristics of patients with Hodgkin's lymphoma
Patients' characteristics are given in table 2. Two-hundred and fifty-two patients were non-Hodgkin's lymphoma. The median age of the patients was 36 years (range: 15-65) with 189 male and 63 female. The histopathologic subtype of the disease was diffuse large B cell (47%), precursor T lymphoblastic (18.8%), mantle cell (6.92%), peripheral T cell (6.92%), anaplastic large cell (5.42%), follicular (4.74%), immunoblastic (4.34%), Burkitt's (3.25%), nodal marginal zone B cell (1.62%), mycosis fungoides (1.08%).
Table 2: Characteristics of patients with
Hematopoietic stem cell sources and conditioning regimens
Bone marrow (3%), bone marrow with peripheral blood (<1%), peripheral blood with CD34+ selection (3%) and peripheral blood (94%) were used as sources of hematopoietic stem cells.
Non-TBI (total body irradiation) conditioning regimens were used in 88% of the transplantations [BEAM (BCNU, etoposide, cytarabine and melphalan) vs. CBV (cyclophosphamide, BCNU, etoposide)], whereas 12% of the patients underwent TBI containing conditioning regimens for lymphoma.
100-day transplantation-related mortality rate was 11% in all Hodgkin's lymphomas including relapsed and primary refractory cases; whereas the rate was 15% in all non-Hodgkin's lymphomas (9% in CR1/PR1, 13% in sensitive relapse, 22% in primary refractory cases and 3% in resistant relapse) (Table 3).
Table 3: Transplant-related mortality (TRM) in patients with Hodgkin's and non-Hodgkin's lymphoma
The main cause of death in all patients was the relapse of the primary disease (86%) in addition to transplantation-related mortality (14%).
The overall survival rate was 50% in all patients with Hodgkin's lymphoma at 10-year follow-up (Figure 1), 50% in relapsed cases at 10th year (Figure 2) and 49% in primary refractory cases at 5th year (Figure 3); whereas, in patients with non-Hodgkin's lymphoma the overall survival rate at 10th year was 45% in all cases (Figure 4), 65% at 10th year for CR1/PR1 (first complete/partial remission) (Figure 5), 50% at 7th year for sensitive relapse (Figure 6), 24% at 3rd year for primary refractory disease (Figure 7) and 0% at 2nd year for resistant relapse (Figure 8).
Fig 1: Survival of all patients with Hodgkin's lymphoma
Fig 2: Survival of patients with Hodgkin's lymphoma with relapse
Fig 3: Survival of patients with Hodgkin's lymphoma with primary refractory disease
Fig 4: Survival of all patients with non-Hodgkin's lymphoma
Fig 5: Survival of patients with non-Hodgkin's lymphoma with CR1/PR1
Fig 6: Survival of patients with non-Hodgkin's lymphoma with sensitive relapse
Fig 7: Survival of patients with non-Hodgkin's lymphoma with primary refractory disease
Fig 8: Survival of patients with non-Hodgkin's lymphoma with resistant relapse