by
Evgeny Klyuchnikov;
Ulrike Bacher;
Nicolaus M. Kroeger;
Parameswaran N. Hari;
Kwang Woo Ahn;
Jeanette Carreras;
Veronika Bachanova;
Asad Bashey;
Jonathon Cohen;
Anita D'Souza;
César O. Freytes;
Robert Peter Gale;
Siddhartha Ganguly;
Mark S. Hertzberg;
Leona A. Holmberg;
Mohamed A. Kharfan-Dabaja;
Andreas Klein;
Grace H. Ku;
Ginna G. Laport;
Hillard M. Lazarus;
Alan M. Miller;
Alberto Mussetti;
Richard F. Olsson;
Shimon Slavin;
Saad Z. Usmani;
Ravi Vij;
William A. Wood;
David G. Maloney;
Anna M. Sureda;
Sonali M. Smith;
Mehdi Hamadani
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.
by
Veronika Bachanova;
Linda J. Burns;
Kwang Woo Ahn;
Ginna G. Laport;
Görgün Akpek;
Mohamed A. Kharfan-Dabaja;
Taiga Nishihori;
Edward Agura;
Philippe Armand;
Samantha M. Jaglowski;
Mitchell S. Cairo;
Amanda F. Cashen;
Jonathon Cohen;
Anita D'Souza;
César O. Freytes;
Robert Peter Gale;
Siddhartha Ganguly;
Nilanjan Ghosh;
Leona A. Holmberg;
David J. Inwards;
Abraham S. Kanate;
Hillard M. Lazarus;
Adriana K. Malone;
Reinhold Munker;
Alberto Mussetti;
Maxim Norkin;
Tim D. Prestidge;
Jacob M. Rowe;
Prakash Satwani;
Tanya Siddiqi;
Patrick J. Stiff;
Basem M. William;
Baldeep Wirk;
David G. Maloney;
Sonali M. Smith;
Anna M. Sureda;
Jeanette Carreras;
Mehdi Hamadani
Assessment with 18F-fluorodeoxy glucose (FDG)—positron emission tomography (PET) before hematopoietic cell transplantation (HCT) for lymphoma may be prognostic for outcomes. Patients with chemotherapy-sensitive non—Hodgkin lymphoma (NHL) undergoing allogeneic HCT reported to the Center of International Blood and Marrow Transplantation Registry between 2007 and 2012 were included. Pre-HCT PET status (positive versus negative) was determined by the reporting transplantation centers. We analyzed 336 patients; median age was 55 years and 60% were males. Follicular lymphoma (n = 104) was more common than large cell (n = 85), mantle cell (n = 69), and mature natural killer or T cell lymphoma (n = 78); two thirds of the cohort received reduced-intensity conditioning; one half had unrelated donor grafts. Patients underwent PET scanning a median of 1 month (range, .07 to 2.83 months) before HCT; 159 were PET positive and 177 were PET negative. At 3 years, relapse/progression, progression-free survival (PFS), and overall survival (OS) in PET-positive versus PET-negative groups were 40% versus 26%; P = .007; 43% versus 47%; P = .47; and 58% versus 60%; P = .73, respectively. On multivariate analysis, a positive pretransplantation PET was associated with an increased risk of relapse/progression (risk ratio [RR], 1.86; P = .001) but was not associated with worse OS (RR, 1.29, 95% confidence interval [CI], .96 to 1.7; P = .08), PFS (RR, 1.32; 95% CI, .95 to 1.84; P = .10), or nonrelapse mortality (RR, .75; 95% CI, .48 to 1.18; P = .22). PET status conferred no influence on graft-versus-host disease. A positive PET scan before HCT is associated with increased relapse risk but should not be interpreted as a barrier to a successful allograft. PET status does not appear to predict survival after allogeneic HCT for NHL.
by
Mehdi Hamadani;
Wael Saber;
Kwang Woo Ahn;
Jeanette Carreras;
Mitchell S. Cairo;
Timothy S. Fenske;
Robert Peter Gale;
John Gibson;
Gregory A. Hale;
Parameswaran N. Hari;
Jack W. Hsu;
David J. Inwards;
Rammurti T. Kamble;
Anderas Klein;
Dipnarine Maharaj;
David I. Marks;
David A. Rizzieri;
Bipin N. Savani;
Harry C. Schouten;
Edmund K Waller;
Baldeep Wirk;
Hillard M. Lazarus
Patients with chemorefractory mantle cell lymphoma (MCL) have a poor prognosis. We used the Center for International Blood and Marrow Transplant Research database to study the outcome of 202 patients with refractory MCL who underwent allogeneic hematopoietic cell transplantation (allo-HCT) using either myeloablative (MA) or reduced-intensity/nonmyeloablative conditioning (RIC/NST), during 1998-2010. We analyzed nonrelapse mortality (NRM), progression/relapse, progression-free survival (PFS), and overall survival (OS). Seventy-four patients (median age, 54 years) received MA, and 128 patients (median age, 59 years) received RIC/NST. Median follow-up after allo-HCT was 35 months in the MA group and 43 months in the RIC/NST group. At 3 years post-transplantation, no significant between-group differences were seen in terms of NRM (47% in MA versus 43% in RIC/NST; P = .68), relapse/progression (33% versus 32%; P = .89), PFS (20% versus 25%; P = .53), or OS (25% versus 30%; P = .45). Multivariate analysis also revealed no significant between-group differences in NRM, relapse, PFS, or OS; however, receipt of a bone marrow or T cell-depleted allograft was associated with an increased risk of NRM and inferior PFS and OS. Our data suggest that despite a refractory disease state, approximately 25% of patients with MCL can attain durable remission after allo-HCT, and conditioning regimen intensity does not influence outcome of allo-HCT.