Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab. Issue 20 (6th August 2013)

• Record Type: Journal Article
• Authors: Evens, Andrew M.; Vanderplas, Ann; LaCasce, Ann S.; Crosby, Allison L.; Nademanee, Auayporn P.; Kaminski, Mark S.; Abel, Gregory A.; Millenson, Michael; Czuczman, Myron S.; Rodriguez, Maria A.; Niland, Joyce; Zelenetz, Andrew D.; Gordon, Leo I.; Friedberg, Jonathan W.
• Is Part Of: Cancer. Volume 119:Issue 20(2013)
• Page Start: 3662
• Page End: 3671
• Publication Date: 2013-08-06
• Subjects: Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28243
• Languages: English
• ISSNs: 0008-543X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="cncr28243-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Stem cell transplant (SCT)‐related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well‐defined in the post‐rituximab era.</p> </sec> <sec id="cncr28243-sec-0002" sec-type="section"> <title>METHODS</title> <p>Through the National Comprehensive Cancer Network (NCCN) lymphoma outcomes study, 184 patients with relapsed/refractory FL who underwent autologous SCT (autoSCT) or allogenic SCT (alloSCT) following disease relapse after prior rituximab‐based therapy were examined.</p> </sec> <sec id="cncr28243-sec-0003" sec-type="section"> <title>RESULTS</title> <p>Patients who underwent autoSCT (N = 136) were older compared with patients who underwent alloSCT (N = 48) (54 versus 51 years, respectively, <italic>P</italic> = .01) and more frequently had grade 3 FL (35% versus 8%, respectively, <italic>P</italic> = .006). Patients who underwent alloSCT received more prior therapies (4 versus 3, respectively, <italic>P</italic> < .0001) and more often had resistant disease at SCT (19% versus 6%, respectively, <italic>P</italic> = .008). Cumulative 100‐day nonrelapse mortality (NRM) for autoSCT and alloSCT were 1% and 6%, respectively (<italic>P</italic> < .0001), whereas 3‐year NRM rates were 3% versus 24%, respectively (<italic>P</italic> < .0001). For autoSCT and alloSCT, cumulative rates of relapse, progression, and/or transformation were 32% versus 16%, respectively (<italic>P</italic> = .03), whereas 3‐year overall survival rates were 87% versus 61% (<italic>P</italic> < .0001); there were no differences in failure‐free survival. AlloSCT was associated with increased risk of death on multivariate analysis (hazard ratio = 2.77, 95% confidence interval = 1.46‐5.26, <italic>P</italic> = .002). This finding persisted on propensity scoring/matching. Multivariate analysis for autoSCT patients identified age > 60 years and > 3 prior therapies as adverse factors. Furthermore, a survival model was created for the autoSCT cohort based on number of factors present (0, 1, 2); 3‐year failure‐free survival was 72%, 47%, and 20%, respectively (<italic>P</italic> = .0003), and 3‐year overall survival was 96%, 82%, and 62%, respectively (<italic>P</italic> < .0001).</p> </sec> <sec id="cncr28243-sec-0004" sec-type="section"> <title>CONCLUSIONS</title> <p>AutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. <bold><italic>Cancer</italic> 2013;119:3662–3671</bold>. © <italic>2013 American Cancer Society</italic>.</p> </sec> </abstract>