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Blood, 15 November 2003, Vol. 102, No. 10, pp. 3521-3529.
Prepublished online as a Blood First Edition Paper on July 31, 2003; DOI 10.1182/blood-2003-04-1205.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma
Koen van Besien,
Fausto R. Loberiza, Jr,
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. Douglas Rizzo, and
Julie M. Vose
From the Lymphoma Working Committee of the International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee; University of Chicago, IL; University of Nebraska Medical Center, Omaha; University of California, La Jolla; University of Minnesota, Minneapolis; University of Texas, Health Science Center, San Antonio; Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Mayo Clinic and Foundation, Rochester, MN; Bristol Children's Hospital, Bristol, United Kingdom; Hospital Sant Creu I Sant Pau, Barcelona, Spain; Oregon Health and Sciences University, Portland; City of Hope National Medical Center, Duarte, CA; Fundación Para Combatir La Leucemia (FUNDALEU), Buenos Aires, Argentina; The Cancer Center at Hackensack University Medical Center, NJ; University Hospital Maastricht, the Netherlands; University of North Carolina, Chapel Hill; and Case Western Reserve University Hospital, Cleveland, OH.
In this article, we report on 904 patients undergoing transplantation for follicular lymphoma. A total of 176 (19%) received allogeneic, 131 (14%) received purged autologous, and 597 (67%) received unpurged autologous transplants. Five-year treatment-related mortality (TRM) rates were 30%, 14%, and 8% and 5-year recurrence rates were 21%, 43%, and 58% after allotransplantation, purged autotransplantation, and unpurged autotransplantation, respectively. In multivariate analyses, allotransplantation had higher TRM and lower disease recurrence. Purged autotransplantation had a 26% lower recurrence risk than unpurged autotransplantation. Five-year probabilities of survival were 51%, 62%, and 55% after allogeneic, purged autotransplantation, and unpurged autotransplantation, respectively. Advanced age, prolonged interval from diagnosis to transplantation, high lactate dehydrogenase (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. 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 increased TRM. We did not detect a correlation between graft-versus-host disease (GVHD) and recurrence. Finally, outcomes of transplantation for follicular lymphoma show improvement over the past decade. (Blood. 2003;102:3521-3529)
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