Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000–2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.
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We would like to acknowledge the following working committee members for their contributions to the manuscript: Mahmoud D Aljurf, Siddhartha Ganguly, Mark S Hertzberg, Leona A Holmberg, Andreas Klein, Taiga Nishihori, Richard F Olsson and Nishitha M Reddy. Also, Maggie Simaytis for administrative assistance. The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a Contract No. HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants (N00014-13-1-0039 and N00014-14-1-0028) from the Office of Naval Research; and grants from *Actinium Pharmaceuticals; Allos Therapeutics Inc.; *Amgen Inc.; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; *Blue Cross and Blue Shield Association; *Celgene Corporation; Chimerix Inc.; Fred Hutchinson Cancer Research Center; Fresenius-Biotech North America Inc.; *Gamida Cell Teva Joint Venture Ltd; Genentech Inc.;*Gentium SpA; Genzyme Corporation; GlaxoSmithKline; Health Research Inc. Roswell Park Cancer Institute; HistoGenetics Inc.; Incyte Corporation; Jeff Gordon Children’s Foundation; Kiadis Pharma; The Leukemia & Lymphoma Society; Medac GmbH; The Medical College of Wisconsin; Merck & Co. Inc.; Millennium: The Takeda Oncology Co.; *Milliman USA Inc.; *Miltenyi Biotec Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions Inc.; Osiris Therapeutics Inc.; Otsuka America Pharmaceutical Inc.; Perkin-Elmer Inc.; *Remedy Informatics; *Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix Inc.; St Baldrick’s Foundation; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software Inc.; Swedish Orphan Biovitrum; *Tarix Pharmaceuticals; *TerumoBCT; *Teva Neuroscience Inc.; *THERAKOS Inc.; University of Minnesota; University of Utah; and *Wellpoint Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the US Government.
The authors declare no conflict of interest.
Presented in part as an oral presentation at the annual meetings of the American Society of Clinical Oncology, Chicago, IL, May 31, 2015.
Supplementary Information accompanies this paper on Bone Marrow Transplantation website
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Klyuchnikov, E., Bacher, U., Woo Ahn, K. et al. Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma. Bone Marrow Transplant 51, 58–66 (2016). https://doi.org/10.1038/bmt.2015.223
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