Reduced intensity conditioning HLA identical sibling donor allogeneic stem cell transplantation for patients with follicular lymphoma: long-term follow-up from two prospective multicenter trials.
BACKGROUND
Allogeneic hematopoietic stem cell transplantation is an effective treatment for patients with poor risk lymphoma, at least in part because of the graft-versus-lymphoma effect. Over the past decade, reduced intensity conditioning regimens have been shown to offer results similar to those of conventional high-dose conditioning regimens but with lower toxicity early after transplantation, especially in patients with chemosensitive disease at transplant.


METHODS
The aim of this study was to analyze the long-term outcome of patients with follicular lymphoma who received an HLA identical sibling allogeneic stem cell transplant with a reduced intensity conditioning regimen within prospective trials. The prospective multicenter studies considered included 37 patients with follicular lymphoma who underwent allogeneic stem cell transplantation between 1998 and 2007 with a fludarabine plus melphalan-based reduced intensity conditioning regimen.


RESULTS
The median age of the patients was 50 years (range, 34-62 years) and the median follow-up was 52 months (range, 0.6 to 113 months). Most patients (77%) had stage III-IV at diagnosis, and patients had received a median of three lines of therapy before the reduced intensity conditioning allogeneic stem cell transplantation. At the time of transplantation, 14 patients were in complete remission, 16 in partial remission and 7 had refractory or progressive disease after salvage chemotherapy. The 4-year overall survival rates for patients in complete remission, partial remission, or with refractory or progressive disease were 71%, 48% and 29%, respectively (P=0.09), whereas the 4-year cumulative incidences of non-relapse mortality were 26% (95% CI, 11-61), 33% (95% CI, 16-68) and 71% (95% CI, 44-100), respectively. The incidence of relapse for the whole group was only 8% (95% CI, 2-23).


CONCLUSIONS
We conclude that this strategy of reduced intensity conditioning allogeneic stem cell transplantation may be associated with significant non-relapse mortality in heavily pre-treated patients with follicular lymphoma, but a remarkably low relapse rate. Long-term survival is likely in patients without progressive or refractory disease at the time of transplantation.
Piñana
José Luis
JL
Division of Clinical Hematology, Hospital de la Santa Creu i, Sant Pau St Antoni M Claret 167 Barcelona 08021, Spain. jpinana@hospitalmanises.es
Martino
Rodrigo
R
Gayoso
Jorge
J
Sureda
Anna
A
de la Serna
Javier
J
Díez-Martín
Jose Luis
JL
Vazquez
Lourdes
L
Arranz
Reyes
R
Tomás
José Francisco
JF
Sampol
Antonia
A
Solano
Carlos
C
Delgado
Julio
J
Sierra
Jorge
J
Caballero
Dolores
D
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D035781:Siblings; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome