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Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors
Univ Canc Ctr Hamburg, Dept Stem Cell Transplantat, Hamburg, Germany..
Univ Gottingen, Dept Hematol & Internal Oncol, D-37073 Gottingen, Germany..
Univ Canc Ctr Hamburg, Dept Stem Cell Transplantat, Hamburg, Germany..
Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
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2015 (English)In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 12, 2091-2099 p.Article in journal (Refereed) Published
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Abstract [en]

This study was conducted to compare long-term outcomes in patients with refractory/relapsed grades 1 and 2 follicular lymphoma (FL) after allogeneic (allo) versus autologous (auto) hematopoietic cell transplantation (HCT) in the rituximab era. Adult patients with relapsed/refractory grades 1 and 2 FL undergoing first reduced-intensity allo-HCT or first autograft during 2000 to 2012 were evaluated. A total of 518 rituximab-treated patients were included. Allo-HCT patients were younger and more heavily pretreated, and more patients had advanced stage and chemoresistant disease. The 5-year adjusted probabilities, comparing auto-HCT versus allo-HCT groups for nonrelapse mortality (NRM) were 5% versus 26% (P <.0001); relapse/progression: 54% versus 20% (P <.0001); progression-free survival (PFS): 41% versus 58% (P <.001), and overall survival (OS): 74% versus 66% (P =.05). Auto-HCT was associated with a higher risk of relapse/progression beyond 5 months after HCT (relative risk [RR], 4.4; P <.0001) and worse PFS (RR, 2.9; P <.0001) beyond 11 months after HCT. In the first 24 months after HO', auto-HCT was associated with improved OS (RR,.41; P <.0001), but beyond 24 months, it was associated with inferior OS (RR, 2.2; P =.006). A landmark analysis of patients alive and progression-free at 2 years after HO' confirmed these observations, showing no difference in further NRM between both groups, but there was significantly higher risk of relapse/progression (RR, 7.3; P <.0001) and inferior PFS (RR, 3.2; P <.0001) and OS (RR, 2.1; P =.04) after auto-HCT. The 10-year cumulative incidences of second hematological malignancies after allo-HCT and auto-HCT were 0% and 7%, respectively. Auto-HCT and reduced-intensity conditioned allo-HCT as first transplantation approach can provide durable disease control in grades 1 and 2 FL patients. Continued disease relapse risk after auto-HCT translates into improved PFS and OS after allo-HCT in long-term survivors.

Place, publisher, year, edition, pages
2015. Vol. 21, no 12, 2091-2099 p.
Keyword [en]
Grade 1 and 2 follicular lymphoma, Reduced-intensity allogeneic hematopoietic cell transplantation, Autologous hematopoietic cell transplantation, Long-time survival
National Category
Hematology
Identifiers
URN: urn:nbn:se:uu:diva-270421DOI: 10.1016/j.bbmt.2015.07.028ISI: 000364981700009PubMedID: 26253007OAI: oai:DiVA.org:uu-270421DiVA: diva2:910428
Available from: 2016-03-09 Created: 2015-12-28 Last updated: 2017-11-30Bibliographically approved

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Olsson, Richard F.

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Centrum för klinisk forskning i Sörmland (CKFD)
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