Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab: A comprehensive analysis from the NCCN lymphoma outcomes project

Andrew M. Evens*, Ann Vanderplas, Ann S. Lacasce, Allison L. Crosby, Auayporn P. Nademanee, Mark S. Kaminski, Gregory A. Abel, Michael Millenson, Myron S. Czuczman, Maria A. Rodriguez, Joyce Niland, Andrew D. Zelenetz, Leo I. Gordon, Jonathan W. Friedberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3662-3671
Number of pages10
JournalCancer
Volume119
Issue number20
DOIs
StatePublished - Oct 15 2013

Keywords

  • allogeneic transplantation
  • autologous transplantation
  • follicular lymphoma
  • non-Hodgkin lymphoma
  • prognostication
  • rituximab
  • stem cell transplantation
  • survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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