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

ISSN
1523-6536
1083-8791
Date Issued
2015
Author(s)
Klyuchnikov, Evgeny
Kroeger, Nicolaus M.
Hari, Parameswaran N.
Ahn, Kwang Woo
Carreras, Jeanette
Bachanova, Veronika
Bashey, Asad
Cohen, Jonathon B.
D'Souza, Anita
Freytes, Cesar O.
Gale, Robert Peter
Ganguly, Siddhartha
Hertzberg, Mark S.
Holmberg, Leona A.
Kharfan-Dabaja, Mohamed A.
Klein, Andreas
Ku, Grace H.
Laport, Ginna G.
Lazarus, Hillard M.
Miller, Anne-Marie
Mussetti, Alberto
Olsson, Richard F.
Slavin, Shimon
Usmani, Saad Z.
Vij, Ravi
Wood, William Allen
Maloney, David G.
Sureda, Anna M.
Smith, Sonali M.
Hamadani, Mehdi
DOI
10.1016/j.bbmt.2015.07.028
Abstract
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. (C) 2015 American Society for Blood and Marrow Transplantation.