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Author Notes:

Corresponding author: Mehdi Hamadani, MD, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Suite C5500, Milwaukee, WI 53226, USA; Phone: 414-805-0643; Fax: 414-805-0714; mhamadani@mcw.edu.

We would like to acknowledge the following for their contributions to the manuscript: Mahmoud Aljurf, Ernesto Ayala, Amanda Cashen, Andy Chen, Yi-Bin Chen, Marcos de Lima, James Gajewski, Nilanjan Ghosh, Rummurti Kamble, Rodrigo Martino, Reinhold Munker, Taiga Nishihori, Nishitha Reddy, David Rizzieri, Bipin Savani, Harry C. Schouten, Peter Wiernik and Baldeep Wirk. Maggie Simaytis for administrative assistance.

Financial Disclosure Statement: There are no relevant conflicts of interest to disclose.

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Research Funding:

The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from various organizations and companies.

For complete funding information, please see the full article.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology
  • Immunology
  • Transplantation
  • Grade 1 and 2 follicular lymphoma
  • Reduced-intensity allogeneic hematopoietic cell transplantation
  • Autologous hematopoietic cell transplantation
  • Long-time survival
  • STEM-CELL TRANSPLANTATION
  • PROGRESSION-FREE SURVIVAL
  • NON-HODGKINS-LYMPHOMA
  • HIGH-DOSE THERAPY
  • FOLLOW-UP
  • ALLOGENEIC TRANSPLANTATION
  • AUTOLOGOUS TRANSPLANTATION
  • RITUXIMAB
  • EBMT
  • RELAPSE

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

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Journal Title:

Biology of Blood and Marrow Transplantation

Volume:

Volume 21, Number 12

Publisher:

, Pages 2091-2099

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Purpose: Comparison of long-term outcomes in patients with refractory/relapsed grade 1-2 follicular lymphoma (FL) after allogeneic (allo-HCT) vs. autologous hematopoietic cell transplantation (auto-HCT) in the rituximab-era. Methods: Adult patients with relapsed/refractory grade 1-2 FL undergoing 1st reduced-intensity allo-HCT or 1st autograft during 2000-2012 were evaluated. Results: A total of 518 rituximab-treated patients were included. Allo-HCT patients were younger; more heavily pretreated, and more patients had advanced stage and chemoresistant disease. The 5-year adjusted probabilities, comparing auto- vs. allo-HCT groups for non-relapse mortality (NRM) were 5% vs. 26% (p<0.0001); relapse/progression: 54% vs. 20% (p<0.0001); progression-free survival (PFS): 41% vs. 58% (p<0.001) and overall survival (OS): 74% vs. 66% (p=0.05). Auto-HCT was associated with a higher risk of relapse/progression beyond 5 months post-HCT (RR=4.4; p<0.0001), and worse PFS (RR=2.9; p<0.0001) beyond 11 months post HCT. In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.41; p<0.0001), but beyond 24 months with inferior OS (RR=2.2; p=0.006). A landmark analysis of patients alive and progression-free at 2-years post-HCT confirmed these observations, showing no difference in further NRM between both groups, but significantly higher risk of relapse/progression (RR=7.3; p<0.0001) and inferior PFS (RR=3.2; p<0.0001) and OS (RR=2.1; p=0.04) following auto-HCT. The 10-year cumulative incidence of second hematological malignancies following allo- and auto-HCT was 0% and 7%, respectively. Conclusion: Auto- and RIC-allo-HCT as 1st transplantation approach can provide durable disease control in grade 1-2 FL patients. Continued disease relapse-risk following auto-HCT translates into improved PFS and OS following allo-HCT, in long-term survivors.

Copyright information:

© 2015 American Society for Blood and Marrow Transplantation.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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