TY - JOUR
T1 - Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors
AU - Klyuchnikov, Evgeny
AU - Bacher, Ulrike
AU - Kröger, Nicolaus M.
AU - Hari, Parameswaran N.
AU - Ahn, Kwang Woo
AU - Carreras, Jeanette
AU - Bachanova, Veronika
AU - Bashey, Asad
AU - Cohen, Jonathon B.
AU - D'Souza, Anita
AU - Freytes, César O.
AU - Gale, Robert Peter
AU - Ganguly, Siddhartha
AU - Hertzberg, Mark S.
AU - Holmberg, Leona A.
AU - Kharfan-Dabaja, Mohamed A.
AU - Klein, Andreas
AU - Ku, Grace H.
AU - Laport, Ginna G.
AU - Lazarus, Hillard M.
AU - Miller, Alan M.
AU - Mussetti, Alberto
AU - Olsson, Richard F.
AU - Slavin, Shimon
AU - Usmani, Saad Z.
AU - Vij, Ravi
AU - Wood, William A.
AU - Maloney, David G.
AU - Sureda, Anna M.
AU - Smith, Sonali M.
AU - Hamadani, Mehdi
N1 - Publisher Copyright:
© 2015 American Society for Blood and Marrow Transplantation.
PY - 2015/12
Y1 - 2015/12
N2 - 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 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.
AB - 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 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.
KW - Autologous hematopoietic cell transplantation
KW - Grade 1 and 2 follicular lymphoma
KW - Long-time survival
KW - Reduced-intensity allogeneic hematopoietic cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=84947494295&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947494295&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2015.07.028
DO - 10.1016/j.bbmt.2015.07.028
M3 - Article
C2 - 26253007
AN - SCOPUS:84947494295
SN - 1083-8791
VL - 21
SP - 2091
EP - 2099
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -