Autologous vs. Reduced Intensity Allogeneic Hematopoietic Cell Transplantation for Patients with Chemosensitive Follicular Non-Hodgkin's Lymphoma Beyond First Complete Response or First Partial Response
Year of Publication
Tomblyn, M; Ewell, M; Bredeson, C; Kahl, B; Goodman, S; Horowitz, M; Vose, J; Negrin, R; Laport, G
Biol Blood Marrow Transplant
Antibodies; Antineoplastic Combined Chemo; Cyclophosphamide/administration & dosage; Disease-Free Survival; Etoposide/administration & dosage; Female; Monoclonal; Murine-Derived/administration & dosage; Protocols/therapeutic Combined Modality Therapy
Patients with follicular lymphoma (FL) typically experience an indolent course, however, the disease is rarely curable with conventional chemotherapy. Autologous hematopoietic cell transplantation HCT can extend progression-free survival (PFS) and overall survival (OS) but relapse is the primary cause of failure. Allogeneic HCT confers lower relapse rates due to a graft vs lymphoma effect. Reduced intensity conditioning (RIC) allows allogeneic HCT to be done with lower toxicity. The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) conducted a prospective multicenter trial comparing these 2 strategies in FL patients with relapsed, chemotherapy sensitive disease. Patients were assigned a treatment arm based on the availability of an HLA-matched sibling donor (MSD). Those with a MSD underwent allogeneic HCT (n=8) with the FCR preparative regimen (fludarabine, cyclophosphamide(Cy), rituximab(RTX)) and received tacrolimus and methotrexate for graft vs host disease(GVHD) prophylaxis. Patients without a MSD (n=22) underwent mobilization with Cy, RTX, and filgrastim and received a conditioning regimen of either CBV (Cy, carmustine, VP16) or total body irradiation with Cy and VP16. Autologous HCT patients received 4 doses of weekly maintenance RTX (375 mg/m(2)) starting at day+42 post autoHCT. Sixteen patients were in complete remission (CR), 10 patients were in partial remission (PR), and 1 had stable disease after salvage therapy and prior to HCT. Median follow-up was 36 months (range, 1-51 months). OS was 73% vs 100% and PFS was 63% vs 86%, after autologous versus allogeneic HCT respectively. No patients had grade 2-4 acute GVHD; 2 patients developed extensive chronic GVHD. Three autologous recipients died from non-relapse causes. This trial closed early due to slow accrual. We show that the FCR regimen is well tolerated and that both allogeneic and autologous HCT result in promising 3-year OS and PFS in patients with relapsed FL.