The outcome of reduced intensity allogeneic stem cell transplantation and autologous stem cell transplantation when performed as a first transplant strategy in relapsed follicular lymphoma: an analysis from the Lymphoma Working Party of the EBMT

Abstract

Both auto-SCT and reduced intensity allo-SCT (RIST) are employed in the treatment of relapsed follicular lymphoma (FL). We have analysed the outcome of these two transplant procedures when used as a first transplant in this setting. We conducted a retrospective comparison of 726 patients who underwent an auto-SCT and 149 who underwent a RIST as a first transplant procedure for relapsed FL as reported to the Lymphoma Working Party of the European Bone Marrow Transplant. The non-relapse mortality (NRM) was significantly worse for patients undergoing a RIST (relative risk (RR) 4.0, Po0.001). The 1-year NRM was 15% for those undergoing a RIST compared with 3% for those undergoing an auto-SCT. Disease relapse or progression were significantly worse for those receiving an auto-SCT (RR 3.1, Po0.001). Patients undergoing a RIST had a 5-year relapse rate of 20% compared with 47% for those undergoing an auto-SCT. The PFS at 5 years was 57% for patients receiving a RIST compared with 48% for those receiving an auto-SCT. There was no significant difference in OS between the two groups. RIST is associated with a higher NRM and lower relapse rate in patients with relapsed FL.

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

“…With a 3-year OS probability of 29%, survival resembles that reported for second allotransplants for relapsed myeloid malignancies, ranging from 21% after 2 years to 32% after 5 years. [10][11][12][13][14]18 Second allogeneic transplantation for lymphoma relapse K Horstmann et al Importantly, the 3-year NRM of 23% observed here compares well with NRM figures observed in registry studies on first allotransplants in lymphoma, 2,[19][20][21][22][23][24][25] implying that a repeat allotransplant does not seem to be associated with an unacceptable increase in NRM.…”

“…12 Notably, although this subset analysis was limited by small numbers, patients with mantle cell lymphoma and diffuse large B-cell lymphoma did not benefit from a second alloHSCT, whereas long-term PFS after alloHSCT occurred in a substantial proportion of patients with HL, TCL and, in particular, indolent lymphoma. Although the 20-30% PFS plateaus observed seem to be inferior to 3-year PFS rates ranging from 25 to 60% in registry studies on first allotransplants in HL, TCL and follicular lymphoma, 19,20,[25][26][27] this outcome is in line with circumstantial evidence suggesting that these three entities are more susceptible to GVL than aggressive B-cell lymphoma. 24,28 In addition, the finding that in many patients chronic GVHD was absent after alloHSCT_1 but not after alloHSCT_2 is consistent with the conclusion that a second allotransplant might induce an effective allo-response in patients in whom it failed to appear after the first transplant, even if we were not able to show a direct correlation between chronic GVHD and disease control after alloHSCT_2.…”

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

“…16,49 More recent registry studies report a median age between 49 and 57 years. 39,40,44,53 Patients undergoing ASCT continue to be younger patients despite reasonable NRM in the transplanted population. Toxicity in the ASCT population is well managed in the modern era, with NRM ranging from 3% to 5%.…”

“…Toxicity in the ASCT population is well managed in the modern era, with NRM ranging from 3% to 5%. 44,49,53 A summary of the efficacy outcomes of key ASCT studies is provided in Table 2.…”

Transplantation in follicular lymphoma: not "yes or no" but "whom and when"

“…In a recently published retrospective analysis of EBMT Registry data on patients in 2 nd or higher treatment line, the survival curves for progression free (PFS) and overall (OS) survival appear to cross in favor of allogeneic SCT beyond the 2 nd or the 8 th year, respectively, despite an adverse risk profile of the allo-transplanted cohorts. 2 So, in the light of these improvements, could allogeneic SCT become the standard treatment for all eligible patients in relapse?…”