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Comparative Study
. 2018 Jun 15;124(12):2541-2551.
doi: 10.1002/cncr.31374. Epub 2018 Apr 12.

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

Sonali M Smith  1 , James Godfrey  2 , Kwang Woo Ahn  3   4 , Alyssa DiGilio  3 , Sairah Ahmed  5 , Vaibhav Agrawal  6 , Veronika Bachanova  7 , Ulrike Bacher  8   9 , Asad Bashey  10 , Javier Bolaños-Meade  11 , Mitchell Cairo  12 , Andy Chen  13 , Saurabh Chhabra  14 , Edward Copelan  15 , Parastoo B Dahi  16 , Mahmoud Aljurf  17 , Umar Farooq  18 , Siddhartha Ganguly  19 , Mark Hertzberg  20 , Leona Holmberg  21 , David Inwards  22 , Abraham S Kanate  23 , Reem Karmali  24 , Vaishalee P Kenkre  25 , Mohamed A Kharfan-Dabaja  26 , Andreas Klein  27 , Hillard M Lazarus  28 , Matthew Mei  29 , Alberto Mussetti  30 , Taiga Nishihori  26 , Praveen Ramakrishnan Geethakumari  31 , Ayman Saad  32 , Bipin N Savani  33 , Harry C Schouten  34 , Nirav Shah  14 , Alvaro Urbano-Ispizua  35   36   37 , Ravi Vij  38 , Julie Vose  39 , Anna Sureda  40 , Mehdi Hamadani  3
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Comparative Study

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

Sonali M Smith et al. Cancer. .

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.

Keywords: allogeneic transplantation; autologous transplantation; chemoimmunotherapy; early treatment failure; follicular lymphoma; rituximab.

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Conflict of interest statement

Disclosure of conflict of interest: No disclosures to report.

Figures

Figure 1
Figure 1
(a) Adjusted probabilities of non-relapse mortality (NRM), (b) relapse, (c) progression-free survival (PFS), and (d) overall survival (OS) for patients who underwent autologous (auto) hematopoietic cell transplantation versus matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic transplant.
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