Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma
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Summary of report on mortality and recurrence rate.
Type of stem cell transplant
|
Treatment-related mortality (TRM)
|
5-year Recurrence Rate
|
| 176 (19%) - allogeneic (donor) |
30% |
21%,
|
| 131 (14%) - purged autologous |
14% |
43% |
| 597 (67%) - unpurged autologous transplantation |
8% |
58% |
"We report 904 patients undergoing transplantation for follicular lymphoma.
Five-year treatment-related mortality (TRM) was 30%, 14% and 8% and five-year recurrence rate was 21%, 43% and 58% after allotransplantation, purged and unpurged autotransplantation, respectively.
In multivariate analysis, allotransplantation had a fourfold increase in TRM, but a 50% decrease in recurrence.
Purged autotransplant had a 26% lower recurrence risk than unpurged.
Five-year probabilities of survival were 51%, 62% and 55% after allogeneic; purged and unpurged autotransplantation, respectively.
Advanced age, prolonged interval from diagnosis to transplantation, high LDH, refractory disease, bone
marrow involvement, low performance scores and transplantation between 1990 and 1993 were associated with adverse outcomes.
Total body irradiation was associated with higher TRM but lower recurrence.
(A new study that uses High dose bexxar as substitute.)
There was no association between acute or chronic graft-versus-host disease and recurrence after allotransplantation.
We conclude that both allogeneic and autologous transplantation can induce durable remissions.
There may be a benefit to graft purging in autologous transplantation.
The decreased recurrence after allotransplantation is offset by an increased TRM.
We did not detect a correlation between GVHD and recurrence.
Finally, outcomes of transplantation for follicular lymphoma show improvement over the past decade."
Koen van Besien*, Fausto R Loberiza, Ruta Bajorunaite, James O Armitage, Asad Bashey, Linda J Burns, Cesar O Freytes, John Gibson, Mary M Horowitz, David J Inwards, David I Marks, Rodrigo Martino, Richard T Maziarz, Arturo Molina, Santiago Pavlovsky, Andrew L Pecora, Harry C Schouten, Thomas C Shea, Hillard M Lazarus, J D Rizzo, and Julie M Vose
Department of Hematology/Oncology, University of Chicago, Chicago, IL, USA Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI, USA Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA Department of Hematology/Oncology, University of California, La Jolla, CA, USA Department of Medicine, University of Minnesota, Minneapolis, MN, USA Department of Medicine, University of Texas, Health Science Center, San Antonio, TX, USA Department of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia Department of Hematology, Mayo Clinic and Foundation, Rochester, MN, USA Department of Oncology, Bristol Children's Hospital, Bristol, England, United Kingdom Department of Hematologia, Hospital Sant Creu I Sant Pau, Barcelona, Spain Oregon Health & Sciences University, Portland, OR, USA Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA, USA FUNDALEU, Buenos Aires, Argentina The Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
Department of Internal Medical Hematology, University Hospital Maastricht, Maastricht, The Netherlands
Department of Medical Oncology, University of North Carolina, Chapel Hill, NC, USA Department of Hematology/Oncology, Case Western Reserve University Hospital, Cleveland, OH, USA
* Corresponding author; email: .
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