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: KVBesien@medicine.bsd.uchicago.edu.
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