title: Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma.
abstract: Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.
authors.affiliation: Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Klyuchnikov
authors.affiliation: Department for Hematology/Oncology, Georg August University Göttingen, Göttingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Bacher
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: K
authors.initials: K
authors.lastname: Woo Ahn
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J
authors.initials: J
authors.lastname: Carreras
authors.affiliation: Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
authors.forename: N M
authors.initials: NM
authors.lastname: Kröger
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Hari
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Medicine, University of California, San Diego, CA, USA.
authors.forename: G H
authors.initials: GH
authors.lastname: Ku
authors.affiliation: Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: E
authors.initials: E
authors.lastname: Ayala
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Chen
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Y-B
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: C O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College of London, London, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.affiliation: SC Ematologia e Trapianto Midollo Osseo, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.|Università degli Studi di Milano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mussetti
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Hematology - Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Usmani
authors.affiliation: Our Lady of Mercy Medical Center, Bronx, NY, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Wiernik
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.|European Group for Blood and Marrow Transplantation, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors