TY - JOUR
T1 - Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab
T2 - A comprehensive analysis from the NCCN lymphoma outcomes project
AU - Evens, Andrew M.
AU - Vanderplas, Ann
AU - Lacasce, Ann S.
AU - Crosby, Allison L.
AU - Nademanee, Auayporn P.
AU - Kaminski, Mark S.
AU - Abel, Gregory A.
AU - Millenson, Michael
AU - Czuczman, Myron S.
AU - Rodriguez, Maria A.
AU - Niland, Joyce
AU - Zelenetz, Andrew D.
AU - Gordon, Leo I.
AU - Friedberg, Jonathan W.
PY - 2013/10/15
Y1 - 2013/10/15
N2 - BACKGROUND Stem cell transplant (SCT)-related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well-defined in the post-rituximab era. METHODS Through the National Comprehensive Cancer Network (NCCN) lymphoma outcomes study, 184 patients with relapsed/refractory FL who underwent autologous SCT (autoSCT) or allogenic SCT (alloSCT) following disease relapse after prior rituximab-based therapy were examined. RESULTS Patients who underwent autoSCT (N = 136) were older compared with patients who underwent alloSCT (N = 48) (54 versus 51 years, respectively, P =.01) and more frequently had grade 3 FL (35% versus 8%, respectively, P =.006). Patients who underwent alloSCT received more prior therapies (4 versus 3, respectively, P <.0001) and more often had resistant disease at SCT (19% versus 6%, respectively, P =.008). Cumulative 100-day nonrelapse mortality (NRM) for autoSCT and alloSCT were 1% and 6%, respectively (P <.0001), whereas 3-year NRM rates were 3% versus 24%, respectively (P <.0001). For autoSCT and alloSCT, cumulative rates of relapse, progression, and/or transformation were 32% versus 16%, respectively (P =.03), whereas 3-year overall survival rates were 87% versus 61% (P <.0001); there were no differences in failure-free survival. AlloSCT was associated with increased risk of death on multivariate analysis (hazard ratio = 2.77, 95% confidence interval = 1.46-5.26, P =.002). This finding persisted on propensity scoring/matching. Multivariate analysis for autoSCT patients identified age > 60 years and > 3 prior therapies as adverse factors. Furthermore, a survival model was created for the autoSCT cohort based on number of factors present (0, 1, 2); 3-year failure-free survival was 72%, 47%, and 20%, respectively (P =.0003), and 3-year overall survival was 96%, 82%, and 62%, respectively (P <.0001). CONCLUSIONS AutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. Cancer 2013;119:3662-3671.
AB - BACKGROUND Stem cell transplant (SCT)-related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well-defined in the post-rituximab era. METHODS Through the National Comprehensive Cancer Network (NCCN) lymphoma outcomes study, 184 patients with relapsed/refractory FL who underwent autologous SCT (autoSCT) or allogenic SCT (alloSCT) following disease relapse after prior rituximab-based therapy were examined. RESULTS Patients who underwent autoSCT (N = 136) were older compared with patients who underwent alloSCT (N = 48) (54 versus 51 years, respectively, P =.01) and more frequently had grade 3 FL (35% versus 8%, respectively, P =.006). Patients who underwent alloSCT received more prior therapies (4 versus 3, respectively, P <.0001) and more often had resistant disease at SCT (19% versus 6%, respectively, P =.008). Cumulative 100-day nonrelapse mortality (NRM) for autoSCT and alloSCT were 1% and 6%, respectively (P <.0001), whereas 3-year NRM rates were 3% versus 24%, respectively (P <.0001). For autoSCT and alloSCT, cumulative rates of relapse, progression, and/or transformation were 32% versus 16%, respectively (P =.03), whereas 3-year overall survival rates were 87% versus 61% (P <.0001); there were no differences in failure-free survival. AlloSCT was associated with increased risk of death on multivariate analysis (hazard ratio = 2.77, 95% confidence interval = 1.46-5.26, P =.002). This finding persisted on propensity scoring/matching. Multivariate analysis for autoSCT patients identified age > 60 years and > 3 prior therapies as adverse factors. Furthermore, a survival model was created for the autoSCT cohort based on number of factors present (0, 1, 2); 3-year failure-free survival was 72%, 47%, and 20%, respectively (P =.0003), and 3-year overall survival was 96%, 82%, and 62%, respectively (P <.0001). CONCLUSIONS AutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. Cancer 2013;119:3662-3671.
KW - allogeneic transplantation
KW - autologous transplantation
KW - follicular lymphoma
KW - non-Hodgkin lymphoma
KW - prognostication
KW - rituximab
KW - stem cell transplantation
KW - survival
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U2 - 10.1002/cncr.28243
DO - 10.1002/cncr.28243
M3 - Article
C2 - 23921646
AN - SCOPUS:84885176407
SN - 0008-543X
VL - 119
SP - 3662
EP - 3671
JO - cancer
JF - cancer
IS - 20
ER -
