title: 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.
abstract: 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.
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i, Sant Pau St Antoni M Claret 167 Barcelona 08021, Spain. jpinana@hospitalmanises.es
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Jorge
authors.initials: J
authors.lastname: Gayoso
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Javier
authors.initials: J
authors.lastname: de la Serna
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Díez-Martín
authors.forename: Lourdes
authors.initials: L
authors.lastname: Vazquez
authors.forename: Reyes
authors.initials: R
authors.lastname: Arranz
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Tomás
authors.forename: Antonia
authors.initials: A
authors.lastname: Sampol
authors.forename: Carlos
authors.initials: C
authors.lastname: Solano
authors.forename: Julio
authors.initials: J
authors.lastname: Delgado
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Dolores
authors.initials: D
authors.lastname: Caballero
mesh_terms: 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