title: Favorable outcomes from allogeneic and autologous stem cell transplantation for patients with transformed nonfollicular indolent lymphoma.
abstract: The role of allogeneic (allo-) and autologous stem cell transplantation (auto-SCT) in the management of patients with transformed indolent nonfollicular non-Hodgkin lymphoma is unknown. This is a multicenter, retrospective cohort study of patients with biopsy-proven indolent B cell nonfollicular non-Hodgkin lymphoma and simultaneous or subsequent biopsy-proven aggressive histology transformation who were treated with allo-SCT or auto-SCT between 1996 and 2013. All patients received myeloablative conditioning regimens. Outcomes were compared with a cohort of 246 patients with transformed follicular lymphoma who also underwent allo-SCT (n = 47) or auto-SCT (n = 199) across the same institutions and time frame. Thirty-four patients were identified with the following underlying indolent histologies: 15 (44%) marginal zone lymphoma, 11 (32%) chronic lymphocytic leukemia, 6 (18%) small lymphocytic lymphoma, and 2 (6%) lymphoplasmacytic lymphoma. Patients received various anthracycline or platinum-containing chemotherapy regimens for transformation, incorporating rituximab in 25 (74%). Twelve (35%) subsequently underwent allo-SCT, whereas 33 (65%) underwent auto-SCT. The 3-year overall survival rate after transplantation was 67% (allo-SCT 54%, auto-SCT 74%), and 3-year progression-free survival rate was 49% (allo-SCT 40%, auto-SCT 54%). The 3-year nonrelapse mortality rate was 14% (allo-SCT 15%, auto-SCT 7%). Transplant-related mortality at 100 days was 17% for allo-SCT and 0% for auto-SCT. Adjusted for type of stem cell transplantation, 3-year overall survival, progression-free survival, and nonrelapse mortality rates were similar to those of patients with transformed follicular lymphoma receiving allo-SCT and auto-SCT (P = .38, P = .69, and P = .54, respectively). Allo-SCT and auto-SCT may be reasonable treatments for selected patients with transformed nonfollicular indolent lymphoma, although medium-term outcomes and toxicity appear to be more favorable with auto-SCT.
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada; British Columbia Cancer Agency, Vancouver, British Columbia, Canada. Electronic address: dvilla@bccancer.bc.ca.
authors.forename: Diego
authors.initials: D
authors.lastname: Villa
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Anupkumar
authors.initials: A
authors.lastname: George
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.affiliation: Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Toze
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Crump
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Lee
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
authors.affiliation: Tom Baker Cancer Centre, Calgary, Alberta, Canada.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Stewart
authors.affiliation: Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: MacDonald
authors.affiliation: Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.
authors.forename: Ronan
authors.initials: R
authors.lastname: Foley
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Anargyros
authors.initials: A
authors.lastname: Xenocostas
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sabloff
authors.affiliation: Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Chua
authors.affiliation: Hotel Dieu de Quebec, Quebec City, Quebec, Canada.
authors.forename: Felix
authors.initials: F
authors.lastname: Couture
authors.affiliation: Hôpital de l'enfant Jesus, Quebec City, Quebec, Canada.
authors.forename: Jean F
authors.initials: JF
authors.lastname: Larouche
authors.affiliation: Maisonneuve Rosemont Hôpital, Montreal, Quebec, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Cohen
authors.affiliation: British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Savage
authors.affiliation: British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.affiliation: Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Panzarella
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Carney
authors.affiliation: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Dickinson
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kuruvilla
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D058846:Antibodies, Monoclonal, Murine-Derived; D009944:Organoplatinum Compounds; D000069283:Rituximab
keywords: Allogeneic transplant; Autologous transplant; Rituximab; Transformed lymphoma