Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab: A comprehensive analysis from the NCCN lymphoma outcomes project Journal Article


Authors: Evens, A. M.; Vanderplas, A.; LaCasce, A. S.; Crosby, A. L.; Nademanee, A. P.; Kaminski, M. S.; Abel, G. A.; Millenson, M.; Czuczman, M. S.; Rodriguez, M. A.; Niland, J.; Zelenetz, A. D.; Gordon, L. I.; Friedberg, J. W.
Article Title: Stem cell transplantation for follicular lymphoma relapsed/refractory after prior rituximab: A comprehensive analysis from the NCCN lymphoma outcomes project
Abstract: BACKGROUND Stem cell transplant (SCT)-related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well-defined in the post-rituximab era. METHODS 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. RESULTS Patients who underwent autoSCT (N = 136) were older compared with patients who underwent alloSCT (N = 48) (54 versus 51 years, respectively, P =.01) and more frequently had grade 3 FL (35% versus 8%, respectively, P =.006). Patients who underwent alloSCT received more prior therapies (4 versus 3, respectively, P <.0001) and more often had resistant disease at SCT (19% versus 6%, respectively, P =.008). Cumulative 100-day nonrelapse mortality (NRM) for autoSCT and alloSCT were 1% and 6%, respectively (P <.0001), whereas 3-year NRM rates were 3% versus 24%, respectively (P <.0001). For autoSCT and alloSCT, cumulative rates of relapse, progression, and/or transformation were 32% versus 16%, respectively (P =.03), whereas 3-year overall survival rates were 87% versus 61% (P <.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, P =.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 (P =.0003), and 3-year overall survival was 96%, 82%, and 62%, respectively (P <.0001). CONCLUSIONS AutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. Cancer 2013;119:3662-3671. © 2013 American Cancer Society.
Keywords: survival; rituximab; stem cell transplantation; follicular lymphoma; non-hodgkin lymphoma; allogeneic transplantation; autologous transplantation; prognostication
Journal Title: Cancer
Volume: 119
Issue: 20
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2013-10-15
Start Page: 3662
End Page: 3671
Language: English
DOI: 10.1002/cncr.28243
PROVIDER: scopus
PUBMED: 23921646
DOI/URL:
Notes: --- - "Export Date: 1 November 2013" - "CODEN: CANCA" - "Source: Scopus"
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  1. Andrew D Zelenetz
    767 Zelenetz