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Cancer. 2018 Jun 15;124(12):2541-2551. doi: 10.1002/cncr.31374. Epub 2018 Apr 12.

Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure.

Author information

1
Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.
2
University of Chicago Medicine, Chicago, Illinois.
3
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
The University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Indiana University Simon Cancer Center, Indianapolis, Indiana.
7
Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota.
8
Department of Hematology, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland.
9
Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
10
Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
11
Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
12
Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York.
13
Oregon Health and Science University, Portland, Oregon.
14
Medical College of Wisconsin, Milwaukee, Wisconsin.
15
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
16
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
17
Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
18
Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
19
Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas.
20
Department of Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
21
Fred Hutchinson Cancer Research Center, Seattle, Washington.
22
Division of Hematology, Mayo Clinic, Rochester, Minnesota.
23
Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
24
Northwestern University, Chicago, Illinois.
25
Division of Hematology/Oncology, University of Wisconsin, Madison, Wisconsin.
26
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
27
Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
28
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
29
City of Hope, Duarte, California.
30
Department of Hematology and Pediatric Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation National Cancer Institute, Milan, Italy.
31
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
32
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
33
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
34
Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands.
35
Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
36
August Pi i Sunyer Institute for Biomedical Research, Barcelona, Spain.
37
Josep Carreras Institute of Research, Barcelona, Spain.
38
Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri.
39
Nebraska Medicine, Omaha, Nebraska.
40
Hematology Department, Catalan Institute of Oncology-Hospital, Barcelona, Spain.

Abstract

BACKGROUND:

Early treatment failure (ETF) in follicular lymphoma (FL), defined as relapse or progression within 2 years of frontline chemoimmunotherapy, is a newly recognized marker of poor survival and identifies a high-risk group of patients with an expected 5-year overall survival (OS) rate of approximately 50%. Transplantation is an established option for relapsed FL, but its efficacy in this specific ETF FL population has not been previously evaluated.

METHODS:

This study compared autologous hematopoietic stem cell transplantation (auto-HCT) with either matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic hematopoietic cell transplantation (allo-HCT) as the first transplantation approach for patients with ETF FL (age ≥ 18 years) undergoing auto-HCT or allo-HCT between 2002 and 2014. The primary endpoint was OS. The secondary endpoints were progression-free survival, relapse, and nonrelapse mortality (NRM).

RESULTS:

Four hundred forty FL patients had ETF (auto-HCT, 240; MSD hematopoietic stem cell transplantation [HCT], 105; and MUD HCT, 95). With a median follow-up of 69 to 73 months, the adjusted probability of 5-year OS was significantly higher after auto-HCT (70%) or MSD HCT (73%) versus MUD HCT (49%; P = .0008). The 5-year adjusted probability of NRM was significantly lower for auto-HCT (5%) versus MSD (17%) or MUD HCT (33%; P < .0001). The 5-year adjusted probability of disease relapse was lower with MSD (31%) or MUD HCT (23%) versus auto-HCT (58%; P < .0001).

CONCLUSIONS:

Patients with high-risk FL, as defined by ETF, undergoing auto-HCT for FL have low NRM and a promising 5-year OS rate (70%). MSD HCT has lower relapse rates than auto-HCT but similar OS. Cancer 2018;124:2541-51. © 2018 American Cancer Society.

KEYWORDS:

allogeneic transplantation; autologous transplantation; chemoimmunotherapy; early treatment failure; follicular lymphoma; rituximab

PMID:
29645093
PMCID:
PMC5990449
[Available on 2019-06-15]
DOI:
10.1002/cncr.31374

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