Autologous and Allogeneic Stem-Cell Transplantation for Transformed Follicular Lymphoma: A Report of the Canadian Blood and Marrow Transplant Group

• Published in: Journal of clinical oncology Vol. 31; no. 9; pp. 1164 - 1171
• Main Authors: VILLA, Diego, CRUMP, Michael, RUBINGER, Morel, FOLEY, Ronan, XENOCOSTAS, Anargyros, SABLOFF, Mitchell, MUCCILLI, Alexandra, CHUA, Neil, COUTURE, Felix, LAROUCHE, Jean-François, COHEN, Sandra, CONNORS, Joseph M, PANZARELLA, Tony, AMBLER, Kimberley, AL-TOURAH, Abdulwahab, RAMADAN, Khaled M, KURUVILLA, John, SAVAGE, Kerry J, TOZE, Cynthia L, STEWART, Douglas A, MACDONALD, David A, BUCKSTEIN, Rena, LEE, Christina, ALZAHRANI, Mohsen
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20-03-2013
• Subjects: Adult; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cell Transformation, Neoplastic; Cohort Studies; Disease-Free Survival; Female; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Lymphoma, Follicular - pathology; Lymphoma, Follicular - therapy; Male; Medical sciences; Middle Aged; Multivariate Analysis; Rituximab; Stem Cell Transplantation; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Tumors; Canada; North America; America; Stem cell; Hematopoietic cell; Homograft; B cell neoplasm; Malignant hemopathy; Lymphoid neoplasm; Non Hodgkin lymphoma; Blood group; Cancerology; Allogeneic hematopoietic stem cell transplantation; Lymphoproliferative syndrome; Autologous hematopoietic stem cell transplantation; Follicular lymphoma; Bone marrow; Graft; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2012.44.0693

To determine whether autologous (auto) or allogeneic (allo) stem-cell transplantation (SCT) improves outcome in patients with transformed follicular lymphoma compared with rituximab-containing chemotherapy alone.
This was a multicenter cohort study of patients with follicular lymphoma and subsequent biopsy-proven aggressive histology transformation. Patient, treatment, and outcome data were collected from each transplantation center and combined for analysis. A separate control group was composed of patients with transformation treated with rituximab-containing chemotherapy but not SCT. The primary end point was overall survival (OS) after transformation.
One hundred seventy-two patients were identified: 22 (13%) treated with alloSCT, 97 (56%) with autoSCT, and 53 (31%) with rituximab-containing chemotherapy. Five-year OS after transformation was 46% for patients treated with alloSCT, 65% with autoSCT, and 61% with rituximab-containing chemotherapy (P = .24). Five-year progression-free survival (PFS) after transformation was 46% for those treated with alloSCT, 55% with autoSCT, and 40% with rituximab-containing chemotherapy (P = .12). In multivariate analysis, patients treated with autoSCT had improved OS compared with those who received rituximab-containing chemotherapy (hazard ratio [HR], 0.13; 95% CI, 0.05 to 0.34; P < .001). On the other hand, there was no OS difference between those treated with alloSCT and rituximab-containing chemotherapy (HR, 0.44; 95% CI, 0.16 to 1.24; P = .12). OS and PFS after SCT were similar between those treated with autoSCT and alloSCT. Five-year transplantation-related mortality was 23% for those treated with alloSCT and 5% for autoSCT.
Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity.