High-dose radioimmunotherapy versus conventional high-dose therapy and autologous hematopoietic stem cell transplantation for relapsed follicular non-Hodgkin lymphoma: a multivariable cohort analysis.
We performed a multivariable comparison of 125 consecutive patients with follicular lymphoma (FL) treated at our centers with either high-dose radioimmunotherapy (HD-RIT) using 131I-anti-CD20 (n = 27) or conventional high-dose therapy (C-HDT) (n = 98) and autologous hematopoietic stem cell transplantation. The groups were similar, although more patients treated with HD-RIT had an elevated pretransplantation level of lactate dehydrogenase (41% versus 20%, P =.03) and elevated international prognostic score (41% versus 19%, P =.02). Patients treated with HD-RIT received individualized therapeutic doses of 131I-tositumomab (median, 19.7 GBq [531 mCi]) to deliver 17 to 31 Gy (median, 27 Gy) to critical organs. Patients treated with C-HDT received total body irradiation plus chemotherapy (70%) or chemotherapy alone (30%). Patients treated with HD-RIT experienced improved overall survival (OS) (unadjusted hazard ratio [HR] for death = 0.4 [95% confidence interval (95% CI), 0.2-0.9], P =.02; adjusted HR, 0.3, P =.004) and progression-free survival (PFS) (unadjusted HR =.6 [95% C.I., 0.3-1.0], P =.06; adjusted HR, 0.5, P =.03) versus patients treated with C-HDT. The estimated 5-year OS and PFS were 67% and 48%, respectively, for HD-RIT and 53% and 29%, respectively, for C-HDT. One hundred-day treatment-related mortality was 3.7% in the HD-RIT group and 11% in the C-HDT group. The probability of secondary myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) was estimated to be.076 at 8 years in the HD-RIT group and.086 at 7 years in the C-HDT group. HD-RIT may improve outcomes versus C-HDT in patients with relapsed FL.
Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA. agopal@u.washington.edu
Ajay K
AK
Gopal
Theodore A
TA
Gooley
David G
DG
Maloney
Stephen H
SH
Petersdorf
Janet F
JF
Eary
Joseph G
JG
Rajendran
Sharon A
SA
Bush
Lawrence D
LD
Durack
Jane
J
Golden
Paul J
PJ
Martin
Dana C
DC
Matthews
Frederick R
FR
Appelbaum
Irwin D
ID
Bernstein
Oliver W
OW
Press
D000328:Adult; D018951:Antigens, CD20 / Q000276:immunology*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018450:Disease Progression; D004307:Dose-Response Relationship, Radiation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008224:Lymphoma, Follicular / Q000401:mortality / Q000532:radiotherapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy; D016499:Radioimmunotherapy / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome
D018951:Antigens, CD20; D007457:Iodine Radioisotopes