Comparison of long-term outcomes in patients with refractory/relapsed grade 1-2 follicular lymphoma (FL) after allogeneic (allo-HCT) vs. autologous hematopoietic cell transplantation (auto-HCT) in the rituximab-era

Ahn, Kwang Woo

Bachanova, Veronika

Bacher, Ulrike

Bashey, Asad

Carreras, Jeanette

Cohen, Jonathon B.

D'Souza, Anita

Freytes, César O.

Gale, Robert Peter

Ganguly, Siddhartha

Hamadani, Mehdi

Hari, Parameswaran N.

Hertzberg, Mark S.

Holmberg, Leona A.

Kharfan-Dabaja, Mohamed A.

Klein, Andreas

Klyuchnikov, Evgeny

Kröger, Nicolaus M.

Ku, Grace H.

Laport, Ginna G.

Lazarus, Hillard M.

Maloney, David G.

Miller, Alan M.

Mussetti, Alberto

Olsson, Richard F.

Slavin, Shimon

Smith, Sonali M.

Sureda, Anna M.

Usmani, Saad Z.

Vij, Ravi

Wood, William A.

AbstractThis 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 HCT, 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 HCT 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

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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 

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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

Evgeny Klyuchnikov

Ulrike Bacher

Nicolaus M. Kröger

Parameswaran N. Hari

Kwang Woo Ahn

Jeanette Carreras

Veronika Bachanova

Asad Bashey

Jonathon B. Cohen

Anita D'Souza

César O. Freytes

Robert Peter Gale

Siddhartha Ganguly

Mark S. Hertzberg

Leona A. Holmberg

Mohamed A. Kharfan-Dabaja

Andreas Klein

Grace H. Ku

Ginna G. Laport

Hillard M. Lazarus

Alan M. Miller

Alberto Mussetti

Richard F. Olsson

Shimon Slavin

Saad Z. Usmani

Ravi Vij

William A. Wood

David G. Maloney

Anna M. Sureda

Sonali M. Smith

Mehdi Hamadani

Crossref

Biology of Blood and Marrow Transplantation

https://cdr.lib.unc.edu/downloads/vt150r014

Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors

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Elsevier - Publisher Connector

Carolina Digital Repository

Elsevier - Publisher Connector

Crossref