Allogeneic hematopoietic stem cell transplantation for progressive follicular lymphoma

Abstract

Despite its prolonged disease course compared to other types of lymphoma, most patients eventually succumb to the disease. 1,2 A number of treatment strategies have been explored including radiotherapy, alkylator-based chemotherapy, purine nucleoside analogues and most recently, monoclonal antibodies. Unfortunately, none of these treatments are considered curative for patients with advanced disease and most studies have failed to show a survival advantage over historical controls. [3][4][5][6][7][8] Recently, high-dose chemo/radiotherapy (HDCT) and hematopoietic stem cell transplantation (HSCT) has been used to treat patients with relapsed or refractory follicular lymphoma. The results from early reports of autologous HSCT have been favorable with a low incidence of transplant-related mortality but, unfortunately, many of these patients still experience relapse of lymphoma. 9-16 Allogeneic HSCT may offer an advantage over autologous HSCT by exploiting a graft-versus-lymphoma effect. 17 In keeping with this hypothesis, previous reports of allogeneic HSCT for patients with follicular lymphoma have confirmed a low rate of relapse. 10,12,14,[18][19][20][21][22][23] Despite encouraging results, the experience with allogeneic HSCT for follicular lymphoma remains limited due to both the indolent nature of the disease and the advanced age of the majority of patients when diagnosed. Indeed, several factors may limit the applicability of allogeneic HSCT to a minority of patients with advanced follicular lymphoma and potentially bias results in favor of HSCT over conventional treatments. In most centers, this includes the exclusion of patients over the age of 55 years, as well as the requirement for demonstrating chemosensitive disease before proceeding to HSCT, thus potentially selecting a better risk patient population. Despite these limitations, however, allogeneic HSCT may offer an improved outcome for selected younger patients with advanced follicular lymphoma. Over the past decade, our center has adopted an aggressive allogeneic HSCT approach for patients with progressive follicular lymphoma. This report details the results of a retrospective analysis of the HSCT outcome for this patient population. Patients and methods PatientsBetween January 1993 and December 2000, 24 patients with progressive (23 patients) or primary refractory (one patient) follicular lymphoma underwent HDCT and allogeneic HSCT at the Queen Elizabeth II Health Sciences Centre (QEII HSC), the quaternary referral center for Atlantic Canada. General eligibility criteria for allogeneic HSCT included: (1) age Ͻ56 years (sibling donor) or Ͻ46 years (unrelated donor); (2) satisfactory pre-transplant organ function including left ventricular ejection fraction Ͼ50%, carbon monoxide diffusing capacity Ͼ50% of pre-

Allogeneic transplantation in lymphoma: current status

“…Similar observations were made in single center or registry studies. [50][51][52] The recent study from Japan reported on 38 patients with indolent lymphoma (37 patients had FL) and reported a 2-year OS of 57% with no relapses seen beyond 2 years after transplantation.…”

Myeloablative allogeneic hematopoietic stem cell transplantation for non-Hodgkin lymphoma: a nationwide survey in Japan

“…Moreover, the outcome of allo-HSCT in each histologic subtype has not been fully determined. Previous studies have suggested that allo-HSCT improves the prognosis of patients with advanced follicular lymphoma (FL), 7,10,11 whereas few reports have been published on its benefit in aggressive lymphoma. 12,13 In particular, there has been very little information available on subtypes, including mantle-cell lymphoma 11,14 ; peripheral T-cell lymphoma, unspecified (PTCL) 15 ; natural killer (NK) cell lymphoma 16 ; and anaplastic large cell lymphoma.…”

Follicular lymphoma patients with a high FLIPI score and a high tumor burden: A risk stratification model

“…However, only one study with ASCT in first remission was initiated in the rituximab era 38 . The allogeneic transplantation was examined in relapsed FL and it proved potentially curative, but the first reports on allogeneic transplantation with myeloablative regimens did not resolve whether there is a benefit in OS, mainly due to the high treatment related mortality (21-40%) [39][40][41][42] . Thus, the main focus at the present moment is to explore the efficacy of rituximab maintenance therapy in first remission with or without ASCT, as well the efficacy of radioimmunochemotherapy and allogeneic stem cell transplantation with the reduced-intensity conditioning (RIC) protocols, based on rituximab and fludarabine [43][44][45][46] .…”