Faculty Collaboration Database

Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure. Cancer 2018 Jun 15;124(12):2541-2551

Date

04/13/2018

Pubmed ID

29645093

Pubmed Central ID

PMC5990449

DOI

10.1002/cncr.31374

Scopus ID

2-s2.0-85045242474 (requires institutional sign-in at Scopus site)   51 Citations

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.

Author List

Smith SM, Godfrey J, Ahn KW, DiGilio A, Ahmed S, Agrawal V, Bachanova V, Bacher U, Bashey A, Bolaños-Meade J, Cairo M, Chen A, Chhabra S, Copelan E, Dahi PB, Aljurf M, Farooq U, Ganguly S, Hertzberg M, Holmberg L, Inwards D, Kanate AS, Karmali R, Kenkre VP, Kharfan-Dabaja MA, Klein A, Lazarus HM, Mei M, Mussetti A, Nishihori T, Ramakrishnan Geethakumari P, Saad A, Savani BN, Schouten HC, Shah N, Urbano-Ispizua A, Vij R, Vose J, Sureda A, Hamadani M

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Nirav N. Shah MD Associate Professor in the Medicine department at Medical College of Wisconsin

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

Adult
Aged
Disease Progression
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Lymphoma, Follicular
Male
Middle Aged
Neoplasm Recurrence, Local
Survival Rate
Transplantation Conditioning
Transplantation, Autologous
Transplantation, Homologous
Treatment Failure
Young Adult