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Evens AM , Vanderplas A , LaCasce AS , Crosby AL , Nademanee AP , Kaminski MS , Abel GA , Millenson M , Czuczman MS , Rodriguez MA , Niland J , Zelenetz AD , Gordon LI , Friedberg JW
Stem Cell Transplantation for Follicular Lymphoma Relapsed/Refractory After Prior Rituximab
Cancer. 2013 Oct;119(20) :3662-3671
AbstractBACKGROUNDStem cell transplant (SCT)-related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well-defined in the post-rituximab era. METHODSThrough 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. RESULTSPatients 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). CONCLUSIONSAutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. Cancer 2013;119:3662-3671. (c) 2013 American Cancer Society.
NotesEvens, Andrew M. Vanderplas, Ann LaCasce, Ann S. Crosby, Allison L. Nademanee, Auayporn P. Kaminski, Mark S. Abel, Gregory A. Millenson, Michael Czuczman, Myron S. Rodriguez, Maria A. Niland, Joyce Zelenetz, Andrew D. Gordon, Leo I. Friedberg, Jonathan W.