Autologous Transplantation Versus Allogeneic Transplantation in Patients with Follicular Lymphoma Experiencing Early Treatment Failure
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. (c) 2018 American Cancer Society.
Smith, S., Godfrey, J., Ahn, K., DiGilio, A., Ahmed, S., Agrawal, V., Bachanova, V., Bacher, U., Bashey, A., Bolanos-Meade, J., Cairo, M., Chen, A., Chhabra, S., Copelan, E., Dahi, P., Aljurf, M., Farooq, U., Ganguly, S., Hertzberg, M., Holmberg, L., Inwards, D., Kanate, A., Karmali, R., Kenkre, V., Kharfan-Dabaja, M., Klein, A., Lazarus, H., Mei, M., Mussetti, A., Nishihori, T., Ramakrishnan Geethakumari, P., Saad, A., Savani, B., Schouten, H., Shah, N., Urbano-Ispizua, A., Vij, R., Vose, J., Sureda, A., & 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