Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
In this article, we report on 904 patients undergoing transplantation for follicular lymphoma. A total of 176 (19%) received allogeneic, 131 (14%) received purged autologous, and 597 (67%) received unpurged autologous transplants. Five-year treatment-related mortality (TRM) rates were 30%, 14%, and 8% and 5-year recurrence rates were 21%, 43%, and 58% after allotransplantation, purged autotransplantation, and unpurged autotransplantation, respectively. In multivariate analyses, allotransplantation had higher TRM and lower disease recurrence. Purged autotransplantation had a 26% lower recurrence risk than unpurged autotransplantation. Five-year probabilities of survival were 51%, 62%, and 55% after allogeneic, purged autotransplantation, and unpurged autotransplantation, respectively. Advanced age, prolonged interval from diagnosis to transplantation, high lactate dehydrogenase (LDH), refractory disease, bone marrow involvement, low performance scores, and transplantation between 1990 and 1993 were associated with adverse outcomes. Total body irradiation was associated with higher TRM but lower recurrence. There was no association between acute or chronic graft-versus-host disease and recurrence after allotransplantation. We conclude that both allogeneic and autologous transplantation can induce durable remissions. There may be a benefit to graft purging in autologous transplantation. The decreased recurrence after allotransplantation is offset by increased TRM. We did not detect a correlation between graft-versus-host disease (GVHD) and recurrence. Finally, outcomes of transplantation for follicular lymphoma show improvement over the past decade.
van Besien
Koen
K
Lymphoma Working Committee, International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA. kvbesien@medicine.bsd.uchicago.edu
Loberiza
Fausto R
FR
Bajorunaite
Ruta
R
Armitage
James O
JO
Bashey
Asad
A
Burns
Linda J
LJ
Freytes
Cesar O
CO
Gibson
John
J
Horowitz
Mary M
MM
Inwards
David J
DJ
Marks
David I
DI
Martino
Rodrigo
R
Maziarz
Richard T
RT
Molina
Arturo
A
Pavlovsky
Santiago
S
Pecora
Andrew L
AL
Schouten
Harry C
HC
Shea
Thomas C
TC
Lazarus
Hillard M
HM
Rizzo
J Douglas
JD
Vose
Julie M
JM
D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality* / Q000592:standards; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012008:Recurrence; D012042:Registries; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome