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

Journal Article

2011

Biol Blood Marrow Transplant

17

1051

1051-1057

07/2011

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.