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Prepublished online as a Blood First Edition Paper on July 31, 2003; DOI 10.1182/blood-2003-04-1205.
Submitted April 17, 2003
Accepted July 14, 2003
Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma
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{at}medicine.bsd.uchicago.edu.
We report 904 patients undergoing transplantation for follicular lymphoma. 176 (19%) underwent allogeneic, 131 (14%) purged autologous and 597 (67%) unpurged autologous transplantation. 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. 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.
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