title: Autologous and allogeneic stem-cell transplantation for transformed follicular lymphoma: a report of the Canadian blood and marrow transplant group.
abstract: OBJECTIVE
  To determine whether autologous (auto) or allogeneic (allo) stem-cell transplantation (SCT) improves outcome in patients with transformed follicular lymphoma compared with rituximab-containing chemotherapy alone.
  
  
  METHODS
  This was a multicenter cohort study of patients with follicular lymphoma and subsequent biopsy-proven aggressive histology transformation. Patient, treatment, and outcome data were collected from each transplantation center and combined for analysis. A separate control group was composed of patients with transformation treated with rituximab-containing chemotherapy but not SCT. The primary end point was overall survival (OS) after transformation.
  
  
  RESULTS
  One hundred seventy-two patients were identified: 22 (13%) treated with alloSCT, 97 (56%) with autoSCT, and 53 (31%) with rituximab-containing chemotherapy. Five-year OS after transformation was 46% for patients treated with alloSCT, 65% with autoSCT, and 61% with rituximab-containing chemotherapy (P = .24). Five-year progression-free survival (PFS) after transformation was 46% for those treated with alloSCT, 55% with autoSCT, and 40% with rituximab-containing chemotherapy (P = .12). In multivariate analysis, patients treated with autoSCT had improved OS compared with those who received rituximab-containing chemotherapy (hazard ratio [HR], 0.13; 95% CI, 0.05 to 0.34; P < .001). On the other hand, there was no OS difference between those treated with alloSCT and rituximab-containing chemotherapy (HR, 0.44; 95% CI, 0.16 to 1.24; P = .12). OS and PFS after SCT were similar between those treated with autoSCT and alloSCT. Five-year transplantation-related mortality was 23% for those treated with alloSCT and 5% for autoSCT.
  
  
  CONCLUSIONS
  Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity.
authors: Princess Margaret Cancer Centre, Canada. dvilla@bccancer.bc.ca
authors: Diego
authors: D
authors: Villa
authors: Michael
authors: M
authors: Crump
authors: Tony
authors: T
authors: Panzarella
authors: Kerry J
authors: KJ
authors: Savage
authors: Cynthia L
authors: CL
authors: Toze
authors: Douglas A
authors: DA
authors: Stewart
authors: David A
authors: DA
authors: MacDonald
authors: Rena
authors: R
authors: Buckstein
authors: Christina
authors: C
authors: Lee
authors: Mohsen
authors: M
authors: Alzahrani
authors: Morel
authors: M
authors: Rubinger
authors: Ronan
authors: R
authors: Foley
authors: Anargyros
authors: A
authors: Xenocostas
authors: Mitchell
authors: M
authors: Sabloff
authors: Alexandra
authors: A
authors: Muccilli
authors: Neil
authors: N
authors: Chua
authors: Felix
authors: F
authors: Couture
authors: Jean-François
authors: JF
authors: Larouche
authors: Sandra
authors: S
authors: Cohen
authors: Joseph M
authors: JM
authors: Connors
authors: Kimberley
authors: K
authors: Ambler
authors: Abdulwahab
authors: A
authors: Al-Tourah
authors: Khaled M
authors: KM
authors: Ramadan
authors: John
authors: J
authors: Kuruvilla
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002471:Cell Transformation, Neoplastic; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000069283:Rituximab; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab