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Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors

Overview of attention for article published in Transplantation and Cellular Therapy, August 2015
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Title
Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors
Published in
Transplantation and Cellular Therapy, August 2015
DOI 10.1016/j.bbmt.2015.07.028
Pubmed ID
Authors

Evgeny Klyuchnikov, Ulrike Bacher, Nicolaus M. Kröger, Parameswaran N. Hari, Kwang Woo Ahn, Jeanette Carreras, Veronika Bachanova, Asad Bashey, Jonathon B. Cohen, Anita D'Souza, César O. Freytes, Robert Peter Gale, Siddhartha Ganguly, Mark S. Hertzberg, Leona A. Holmberg, Mohamed A. Kharfan-Dabaja, Andreas Klein, Grace H. Ku, Ginna G. Laport, Hillard M. Lazarus, Alan M. Miller, Alberto Mussetti, Richard F. Olsson, Shimon Slavin, Saad Z. Usmani, Ravi Vij, William A. Wood, David G. Maloney, Anna M. Sureda, Sonali M. Smith, Mehdi Hamadani

Abstract

Comparison of long-term outcomes in patients with refractory/relapsed grade 1-2 follicular lymphoma (FL) after allogeneic (allo-HCT) vs. autologous hematopoietic cell transplantation (auto-HCT) in the rituximab-era. Adult patients with relapsed/refractory grade 1-2 FL undergoing 1(st) reduced-intensity allo-HCT or 1(st) autograft during 2000-2012 were evaluated. A total of 518 rituximab-treated patients were included. Allo-HCT patients were younger; more heavily pretreated, and more patients had advanced stage and chemoresistant disease. The 5-year adjusted probabilities, comparing auto- vs. allo-HCT groups for non-relapse mortality (NRM) were 5% vs. 26% (p<0.0001); relapse/progression: 54% vs. 20% (p<0.0001); progression-free survival (PFS): 41% vs. 58% (p<0.001) and overall survival (OS): 74% vs. 66% (p=0.05). Auto-HCT was associated with a higher risk of relapse/progression beyond 5 months post-HCT (RR=4.4; p<0.0001), and worse PFS (RR=2.9; p<0.0001) beyond 11 months post HCT. In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.41; p<0.0001), but beyond 24 months with inferior OS (RR=2.2; p=0.006). A landmark analysis of patients alive and progression-free at 2-years post-HCT confirmed these observations, showing no difference in further NRM between both groups, but significantly higher risk of relapse/progression (RR=7.3; p<0.0001) and inferior PFS (RR=3.2; p<0.0001) and OS (RR=2.1; p=0.04) following auto-HCT. The 10-year cumulative incidence of second hematological malignancies following allo- and auto-HCT was 0% and 7%, respectively. Auto- and RIC-allo-HCT as 1(st) transplantation approach can provide durable disease control in grade 1-2 FL patients. Continued disease relapse-risk following auto-HCT translates into improved PFS and OS following allo-HCT, in long-term survivors.

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Geographical breakdown

Country Count As %
United States 1 2%
Unknown 50 98%

Demographic breakdown

Readers by professional status Count As %
Researcher 9 18%
Other 7 14%
Professor 4 8%
Professor > Associate Professor 4 8%
Student > Bachelor 3 6%
Other 7 14%
Unknown 17 33%
Readers by discipline Count As %
Medicine and Dentistry 20 39%
Engineering 2 4%
Biochemistry, Genetics and Molecular Biology 1 2%
Nursing and Health Professions 1 2%
Pharmacology, Toxicology and Pharmaceutical Science 1 2%
Other 4 8%
Unknown 22 43%