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Autologous versus reduced-intensity allogeneic hematopoietic cell transplantation for patients with chemosensitive follicular non-Hodgkin lymphoma beyond first complete response or first partial response.
Biol Blood Marrow Transplant. 2011 Jul; 17(7):1051-7.BB

Abstract

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-versus-lymphoma effect. Reduced-intensity conditioning (RIC) allows the performance of allogeneic HCT with lower toxicity. The Blood and Marrow Transplant Clinical Trials Network conducted a prospective multicenter trial comparing these two strategies in patients with relapsed, chemotherapy-sensitive FL. Patients were assigned to a treatment arm based on the availability of an HLA-matched sibling donor (MSD). Those with an MSD underwent allogeneic HCT (n = 8) with the FCR preparative regimen (fludarabine, cyclophosphamide [Cy], rituximab [RTX]) and received tacrolimus and methotrexate for graft-versus-host disease (GVHD) prophylaxis. Those without an MSD (n = 22) underwent mobilization with Cy, RTX, and filgrastim and received a conditioning regimen of either CBV (Cy, carmustine, Etoposide [VP16]) or total body irradiation with Cy and VP16. Patients undergoing autologous HCT received 4 doses of weekly maintenance RTX (375 mg/m²) starting on day +42 post-HCT. Sixteen patients were in complete remission, 10 patients were in partial remission, and 1 patient had stable disease after salvage therapy and before HCT. Median follow-up was 36 months (range, 1-51 months). OS was 73% in autologous HCT versus 100% in allogeneic HCT, and PFS was 63% in autologous HCT versus 86% in allogeneic HCT. No patient had grade II-IV acute GVHD; two patients developed extensive chronic GVHD. Three autologous recipients died from nonrelapse causes. This trial closed early because of 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.

Authors+Show Affiliations

Blood and Marrow Transplant Program, H. Lee Moffitt Cancer and Research Center, Tampa, Florida, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21073974

Citation

Tomblyn, Marcie R., et al. "Autologous Versus Reduced-intensity Allogeneic Hematopoietic Cell Transplantation for Patients With Chemosensitive Follicular non-Hodgkin Lymphoma Beyond First Complete Response or First Partial Response." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 17, no. 7, 2011, pp. 1051-7.
Tomblyn MR, Ewell M, Bredeson C, et al. Autologous versus reduced-intensity allogeneic hematopoietic cell transplantation for patients with chemosensitive follicular non-Hodgkin lymphoma beyond first complete response or first partial response. Biol Blood Marrow Transplant. 2011;17(7):1051-7.
Tomblyn, M. R., Ewell, M., Bredeson, C., Kahl, B. S., Goodman, S. A., Horowitz, M. M., Vose, J. M., Negrin, R. S., & Laport, G. G. (2011). Autologous versus reduced-intensity allogeneic hematopoietic cell transplantation for patients with chemosensitive follicular non-Hodgkin lymphoma beyond first complete response or first partial response. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 17(7), 1051-7. https://doi.org/10.1016/j.bbmt.2010.11.004
Tomblyn MR, et al. Autologous Versus Reduced-intensity Allogeneic Hematopoietic Cell Transplantation for Patients With Chemosensitive Follicular non-Hodgkin Lymphoma Beyond First Complete Response or First Partial Response. Biol Blood Marrow Transplant. 2011;17(7):1051-7. PubMed PMID: 21073974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autologous versus reduced-intensity allogeneic hematopoietic cell transplantation for patients with chemosensitive follicular non-Hodgkin lymphoma beyond first complete response or first partial response. AU - Tomblyn,Marcie R, AU - Ewell,Marian, AU - Bredeson,Christopher, AU - Kahl,Brad S, AU - Goodman,Stacey A, AU - Horowitz,Mary M, AU - Vose,Julie M, AU - Negrin,Robert S, AU - Laport,Ginna G, Y1 - 2010/11/10/ PY - 2010/09/21/received PY - 2010/11/03/accepted PY - 2010/11/16/entrez PY - 2010/11/16/pubmed PY - 2011/10/4/medline SP - 1051 EP - 7 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. VL - 17 IS - 7 N2 - 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-versus-lymphoma effect. Reduced-intensity conditioning (RIC) allows the performance of allogeneic HCT with lower toxicity. The Blood and Marrow Transplant Clinical Trials Network conducted a prospective multicenter trial comparing these two strategies in patients with relapsed, chemotherapy-sensitive FL. Patients were assigned to a treatment arm based on the availability of an HLA-matched sibling donor (MSD). Those with an MSD underwent allogeneic HCT (n = 8) with the FCR preparative regimen (fludarabine, cyclophosphamide [Cy], rituximab [RTX]) and received tacrolimus and methotrexate for graft-versus-host disease (GVHD) prophylaxis. Those without an MSD (n = 22) underwent mobilization with Cy, RTX, and filgrastim and received a conditioning regimen of either CBV (Cy, carmustine, Etoposide [VP16]) or total body irradiation with Cy and VP16. Patients undergoing autologous HCT received 4 doses of weekly maintenance RTX (375 mg/m²) starting on day +42 post-HCT. Sixteen patients were in complete remission, 10 patients were in partial remission, and 1 patient had stable disease after salvage therapy and before HCT. Median follow-up was 36 months (range, 1-51 months). OS was 73% in autologous HCT versus 100% in allogeneic HCT, and PFS was 63% in autologous HCT versus 86% in allogeneic HCT. No patient had grade II-IV acute GVHD; two patients developed extensive chronic GVHD. Three autologous recipients died from nonrelapse causes. This trial closed early because of 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. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/21073974/Autologous_versus_reduced_intensity_allogeneic_hematopoietic_cell_transplantation_for_patients_with_chemosensitive_follicular_non_Hodgkin_lymphoma_beyond_first_complete_response_or_first_partial_response_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(10)00502-1 DB - PRIME DP - Unbound Medicine ER -