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Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure
Author(s) -
Smith Sonali M.,
Godfrey James,
Ahn Kwang Woo,
DiGilio Alyssa,
Ahmed Sairah,
Agrawal Vaibhav,
Bachanova Veronika,
Bacher Ulrike,
Bashey Asad,
BolañosMeade Javier,
Cairo Mitchell,
Chen Andy,
Chhabra Saurabh,
Copelan Edward,
Dahi Parastoo B.,
Aljurf Mahmoud,
Farooq Umar,
Ganguly Siddhartha,
Hertzberg Mark,
Holmberg Leona,
Inwards David,
Kanate Abraham S.,
Karmali Reem,
Kenkre Vaishalee P.,
KharfanDabaja Mohamed A.,
Klein Andreas,
Lazarus Hillard M.,
Mei Matthew,
Mussetti Alberto,
Nishihori Taiga,
Ramakrishnan Geethakumari Praveen,
Saad Ayman,
Savani Bipin N.,
Schouten Harry C.,
Shah Nirav,
UrbanoIspizua Alvaro,
Vij Ravi,
Vose Julie,
Sureda Anna,
Hamadani Mehdi
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31374
Subject(s) - medicine , transplantation , chemoimmunotherapy , follicular lymphoma , hematopoietic stem cell transplantation , surgery , population , clinical endpoint , lymphoma , oncology , rituximab , randomized controlled trial , environmental health
BACKGROUND Early treatment failure (ETF) in follicular lymphoma (FL), defined as relapse or progression within 2 years of frontline chemoimmunotherapy, is a newly recognized marker of poor survival and identifies a high‐risk group of patients with an expected 5‐year overall survival (OS) rate of approximately 50%. Transplantation is an established option for relapsed FL, but its efficacy in this specific ETF FL population has not been previously evaluated. METHODS This study compared autologous hematopoietic stem cell transplantation (auto‐HCT) with either matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic hematopoietic cell transplantation (allo‐HCT) as the first transplantation approach for patients with ETF FL (age ≥ 18 years) undergoing auto‐HCT or allo‐HCT between 2002 and 2014. The primary endpoint was OS. The secondary endpoints were progression‐free survival, relapse, and nonrelapse mortality (NRM). RESULTS Four hundred forty FL patients had ETF (auto‐HCT, 240; MSD hematopoietic stem cell transplantation [HCT], 105; and MUD HCT, 95). With a median follow‐up of 69 to 73 months, the adjusted probability of 5‐year OS was significantly higher after auto‐HCT (70%) or MSD HCT (73%) versus MUD HCT (49%; P = .0008). The 5‐year adjusted probability of NRM was significantly lower for auto‐HCT (5%) versus MSD (17%) or MUD HCT (33%; P < .0001). The 5‐year adjusted probability of disease relapse was lower with MSD (31%) or MUD HCT (23%) versus auto‐HCT (58%; P < .0001). CONCLUSIONS Patients with high‐risk FL, as defined by ETF, undergoing auto‐HCT for FL have low NRM and a promising 5‐year OS rate (70%). MSD HCT has lower relapse rates than auto‐HCT but similar OS. Cancer 2018;124:2541‐51. © 2018 American Cancer Society .