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Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma.
Biol Blood Marrow Transplant. 2018 01; 24(1):78-85.BB

Abstract

Large, multicenter studies comparing commonly used reduced-intensity conditioning (RIC) approaches in follicular lymphoma (FL) have not been performed. Using the Center for International Blood and Marrow Transplant Research database, we report the outcomes of the 2 most commonly used RIC approaches, fludarabine and busulfan (Flu/Bu) versus fludarabine, cyclophosphamide, and rituximab (FCR) in FL patients. We evaluated 200 FL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received RIC with either Flu/Bu (n = 98) or FCR (n = 102) during 2008 to 2014. All patients received peripheral blood grafts, and graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches. Median follow-up of survivors in the Flu/Bu and FCR groups was 48 months and 46 months, respectively. On univariate analysis in the Flu/Bu and FCR groups, the 3-year rates of nonrelapse mortality (11% versus 11%, P = .94), relapse/progression (18% versus 15%, P = .54), progression-free survival (PFS) (71% versus 74%, P = .65), and overall survival (OS) (73% versus 81%, P = .18) were not significantly different. On multivariate analysis no difference was seen between the FCR and Flu/Bu cohorts in terms of grades II to IV (relative risk [RR], 1.06; 95% confidence interval [CI], .59 to 1.93; P = .84) or grades III to IV (RR, 1.18; 95% CI, .47 to 2.99; P = .72) acute GVHD, nonrelapse mortality (RR, .83; 95% CI, .38 to 1.82; P = .64), relapse/progression (RR, .99; 95% CI, .49 to 1.98; P = .97), PFS (RR, .92; 95% CI, .55 to 1.54; P = .76), or OS (RR, .70; 95% CI, .40 to 1.23; P = .21) risk. However, RIC with FCR was associated with a significantly reduced chronic GVHD risk (RR, .52; 95% CI, .36 to .77; P = .001). RIC with either Flu/Bu or FCR in patients with FL undergoing allo-HCT provides excellent 3-year OS, with acceptable rates of nonrelapse mortality. FCR-based conditioning was associated with a lower risk of chronic GVHD.

Authors+Show Affiliations

Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology, The Ohio State University Medical Center, Columbus, Ohio.Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.Department of Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.Division of Hematology, The Ohio State University Medical Center, Columbus, Ohio.Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas.Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin.Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.Servei d'Hematologica, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois.Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: mhamadani@mcw.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29032272

Citation

Epperla, Narendranath, et al. "Fludarabine and Busulfan Versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 24, no. 1, 2018, pp. 78-85.
Epperla N, Ahn KW, Armand P, et al. Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma. Biol Blood Marrow Transplant. 2018;24(1):78-85.
Epperla, N., Ahn, K. W., Armand, P., Jaglowski, S., Ahmed, S., Kenkre, V. P., Savani, B., Jagasia, M., Shah, N. N., Fenske, T. S., Sureda, A., Smith, S. M., & Hamadani, M. (2018). Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 24(1), 78-85. https://doi.org/10.1016/j.bbmt.2017.10.011
Epperla N, et al. Fludarabine and Busulfan Versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma. Biol Blood Marrow Transplant. 2018;24(1):78-85. PubMed PMID: 29032272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma. AU - Epperla,Narendranath, AU - Ahn,Kwang Woo, AU - Armand,Philippe, AU - Jaglowski,Samantha, AU - Ahmed,Sairah, AU - Kenkre,Vaishalee P, AU - Savani,Bipin, AU - Jagasia,Madan, AU - Shah,Nirav N, AU - Fenske,Timothy S, AU - Sureda,Anna, AU - Smith,Sonali M, AU - Hamadani,Mehdi, Y1 - 2017/10/13/ PY - 2017/08/23/received PY - 2017/10/05/accepted PY - 2017/10/17/pubmed PY - 2019/3/9/medline PY - 2017/10/17/entrez KW - Allogeneic HCT KW - FCR KW - Flu/Bu KW - Follicular lymphoma KW - Reduced-intensity conditioning SP - 78 EP - 85 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 24 IS - 1 N2 - Large, multicenter studies comparing commonly used reduced-intensity conditioning (RIC) approaches in follicular lymphoma (FL) have not been performed. Using the Center for International Blood and Marrow Transplant Research database, we report the outcomes of the 2 most commonly used RIC approaches, fludarabine and busulfan (Flu/Bu) versus fludarabine, cyclophosphamide, and rituximab (FCR) in FL patients. We evaluated 200 FL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received RIC with either Flu/Bu (n = 98) or FCR (n = 102) during 2008 to 2014. All patients received peripheral blood grafts, and graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches. Median follow-up of survivors in the Flu/Bu and FCR groups was 48 months and 46 months, respectively. On univariate analysis in the Flu/Bu and FCR groups, the 3-year rates of nonrelapse mortality (11% versus 11%, P = .94), relapse/progression (18% versus 15%, P = .54), progression-free survival (PFS) (71% versus 74%, P = .65), and overall survival (OS) (73% versus 81%, P = .18) were not significantly different. On multivariate analysis no difference was seen between the FCR and Flu/Bu cohorts in terms of grades II to IV (relative risk [RR], 1.06; 95% confidence interval [CI], .59 to 1.93; P = .84) or grades III to IV (RR, 1.18; 95% CI, .47 to 2.99; P = .72) acute GVHD, nonrelapse mortality (RR, .83; 95% CI, .38 to 1.82; P = .64), relapse/progression (RR, .99; 95% CI, .49 to 1.98; P = .97), PFS (RR, .92; 95% CI, .55 to 1.54; P = .76), or OS (RR, .70; 95% CI, .40 to 1.23; P = .21) risk. However, RIC with FCR was associated with a significantly reduced chronic GVHD risk (RR, .52; 95% CI, .36 to .77; P = .001). RIC with either Flu/Bu or FCR in patients with FL undergoing allo-HCT provides excellent 3-year OS, with acceptable rates of nonrelapse mortality. FCR-based conditioning was associated with a lower risk of chronic GVHD. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/29032272/Fludarabine_and_Busulfan_versus_Fludarabine_Cyclophosphamide_and_Rituximab_as_Reduced_Intensity_Conditioning_for_Allogeneic_Transplantation_in_Follicular_Lymphoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(17)30770-X DB - PRIME DP - Unbound Medicine ER -