Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure

Sonali M. Smith, James Godfrey, Kwang Woo Ahn, Alyssa DiGilio, Sairah Ahmed, Vaibhav Agrawal, Veronika Bachanova, Ulrike Bacher, Asad Bashey, Javier Bolaños-Meade, Mitchell Cairo, Andy Chen, Saurabh Chhabra, Edward Copelan, Parastoo B. Dahi, Mahmoud Aljurf, Umar Farooq, Siddhartha Ganguly, Mark Hertzberg, Leona HolmbergDavid Inwards, Abraham S. Kanate, Reem Karmali, Vaishalee P. Kenkre, Mohamed A. Kharfan-Dabaja, Andreas Klein, Hillard M. Lazarus, Matthew Mei, Alberto Mussetti, Taiga Nishihori, Praveen Ramakrishnan Geethakumari, Ayman Saad, Bipin N. Savani, Harry C. Schouten, Nirav Shah, Alvaro Urbano-Ispizua, Ravi Vij, Julie Vose, Anna Sureda, Mehdi Hamadani

Research output: Contribution to journalArticle

17 Scopus 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.

Original languageEnglish (US)
Pages (from-to)2541-2551
Number of pages11
JournalCancer
Volume124
Issue number12
DOIs
StatePublished - Jun 15 2018

Keywords

  • allogeneic transplantation
  • autologous transplantation
  • chemoimmunotherapy
  • early treatment failure
  • follicular lymphoma
  • rituximab

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Smith, S. M., Godfrey, J., Ahn, K. W., DiGilio, A., Ahmed, S., Agrawal, V., Bachanova, V., Bacher, U., Bashey, A., Bolaños-Meade, J., Cairo, M., Chen, A., Chhabra, S., Copelan, E., Dahi, P. B., Aljurf, M., Farooq, U., Ganguly, S., Hertzberg, M., ... Hamadani, M. (2018). Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure. Cancer, 124(12), 2541-2551. https://doi.org/10.1002/cncr.31374