Faculty Collaboration Database

Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003 Nov 15;102(10):3521-9

Date

08/02/2003

Pubmed ID

12893748

DOI

10.1182/blood-2003-04-1205

Scopus ID

2-s2.0-0242411675 (requires institutional sign-in at Scopus site)   315 Citations

Abstract

In this article, we report on 904 patients undergoing transplantation for follicular lymphoma. A total of 176 (19%) received allogeneic, 131 (14%) received purged autologous, and 597 (67%) received unpurged autologous transplants. Five-year treatment-related mortality (TRM) rates were 30%, 14%, and 8% and 5-year recurrence rates were 21%, 43%, and 58% after allotransplantation, purged autotransplantation, and unpurged autotransplantation, respectively. In multivariate analyses, allotransplantation had higher TRM and lower disease recurrence. Purged autotransplantation had a 26% lower recurrence risk than unpurged autotransplantation. Five-year probabilities of survival were 51%, 62%, and 55% after allogeneic, purged autotransplantation, and unpurged autotransplantation, respectively. Advanced age, prolonged interval from diagnosis to transplantation, high lactate dehydrogenase (LDH), refractory disease, bone marrow involvement, low performance scores, and transplantation between 1990 and 1993 were associated with adverse outcomes. Total body irradiation was associated with higher TRM but lower recurrence. There was no association between acute or chronic graft-versus-host disease and recurrence after allotransplantation. We conclude that both allogeneic and autologous transplantation can induce durable remissions. There may be a benefit to graft purging in autologous transplantation. The decreased recurrence after allotransplantation is offset by increased TRM. We did not detect a correlation between graft-versus-host disease (GVHD) and recurrence. Finally, outcomes of transplantation for follicular lymphoma show improvement over the past decade.

Author List

van Besien K, Loberiza FR Jr, Bajorunaite R, Armitage JO, Bashey A, Burns LJ, Freytes CO, Gibson J, Horowitz MM, Inwards DJ, Marks DI, Martino R, Maziarz RT, Molina A, Pavlovsky S, Pecora AL, Schouten HC, Shea TC, Lazarus HM, Rizzo JD, Vose JM

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
J. Douglas Rizzo MD, MS Director, Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Follicular
Male
Middle Aged
Probability
Recurrence
Registries
Remission Induction
Retrospective Studies
Survival Analysis
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome