Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma

E. Klyuchnikov, U. Bacher, K. Woo Ahn, J. Carreras, N. M. Kröger, P. N. Hari, G. H. Ku, E. Ayala, A. I. Chen, Y. B. Chen, J. B. Cohen, C. O. Freytes, R. P. Gale, R. T. Kamble, M. A. Kharfan-Dabaja, H. M. Lazarus, R. Martino, A. Mussetti, B. N. Savani, H. C. SchoutenS. Z. Usmani, P. H. Wiernik, B. Wirk, S. M. Smith, A. Sureda, M. Hamadani

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.

Original languageEnglish (US)
Pages (from-to)58-66
Number of pages9
JournalBone marrow transplantation
Volume51
Issue number1
DOIs
StatePublished - Jan 1 2016

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Klyuchnikov, E., Bacher, U., Woo Ahn, K., Carreras, J., Kröger, N. M., Hari, P. N., Ku, G. H., Ayala, E., Chen, A. I., Chen, Y. B., Cohen, J. B., Freytes, C. O., Gale, R. P., Kamble, R. T., Kharfan-Dabaja, M. A., Lazarus, H. M., Martino, R., Mussetti, A., Savani, B. N., ... Hamadani, M. (2016). Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma. Bone marrow transplantation, 51(1), 58-66. https://doi.org/10.1038/bmt.2015.223