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Robinson et al.42

N = 52 low 15 prior auto SCT (29%) N = 62 intermediate/ high 32 prior auto SCT (52%) N = 22 mantle cell 8 prior auto SCT (36%)

46%

overall PFS: 54% at 2 years 13% at 2 years

0% at 2 years

overall OS: low 65% 47% at 2 years

13% at 2 years

EBMTR retrospective study

Poor outcome in chemoresistant and non-low grade NHL

Bertz et al.43

N = 20 7 prior auto SCT

2 dead at 107 days

Alive in CR at 16, 19, 19 months

Alive at 13,16, 19,19 months

Variety of allograft donor types

Seropian et al.44

N = 21 intermediate/ high N = 7 low 11 prior auto SCT

7% at 100 days 198% overall

57% at 5 years

58% at 5-years

17 ablative and 11 nonablative; 7 in CCR from prior auto SCT

Branson et al.45

N = 38; 10 high

20% at 14 months

50% at 14 months

53% at 14 months

Median follow-up 26 months

Escalón et al.46

N = 10 intermediate/ high; N = 10 low

1 at 10 months

95% 3-year PFS

95% 3-year PFS

Single-center experience

PFS, progression-free survival; OS, overall survival; CR, complete remission; CCR, coutinuous complete remission.

PFS, progression-free survival; OS, overall survival; CR, complete remission; CCR, coutinuous complete remission.

report due to a high treatment-related mortality (46%), but had a favorable outcome in the study from MD Anderson Cancer Center.46 Despite the poor prognostic characteristics of an auto SCT failure, many patients remain alive in complete remission, although for the most part the follow-up period is brief. The single institution report from Escalón et al.46 shows a strikingly excellent outcome of a 95% PFS at 3 years after allo SCT. That such patients can be treated using an initial auto SCT and subsequently salvaged using a reduced-conditioning allo SCT supports the contention of many investigators that poor-risk NHL should receive planned tandem auto SCT followed within months by a reduced-conditioning allo SCT. The rationale is that the auto SCT provides significant tumor cytoreduction allowing maximal antitumor benefit of the new donor effector cells given in the course of an allo SCT.

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