Stem Cell Transplantation for Follicular Lymphoma Relapsed/Refractory After Prior Rituximab

作者：Evens Andrew M^*; Vanderplas Ann; LaCasce Ann S; Cro**y Allison L; Nademanee Auay**** P; Kaminski Mark S; Abel Gregory A; Millenson Michael; Czuczman Myron S; Rodriguez Maria A; Niland Joyce; Zelenetz Andrew D; Gordon Leo I; Friedberg Jonathan W

来源：Cancer, 2013, 119(20): 3662-3671.

DOI：10.1002/cncr.28243

• follicular lymphoma
• prognostication
• autologous transplantation
• allogeneic transplantation
• survival
• rituximab
• non-Hodgkin lymphoma
• stem cell transplantation

BACKGROUNDStem cell transplant (SCT)-related outcomes and prognostication for relapsed/refractory follicular lymphoma (FL) are not well-defined in the post-rituximab era. %26lt;br%26gt;METHODSThrough the National Comprehensive Cancer Network (NCCN) lymphoma outcomes study, 184 patients with relapsed/refractory FL who underwent autologous SCT (autoSCT) or allogenic SCT (alloSCT) following disease relapse after prior rituximab-based therapy were examined. %26lt;br%26gt;RESULTSPatients who underwent autoSCT (N=136) were older compared with patients who underwent alloSCT (N=48) (54 versus 51 years, respectively, P=.01) and more frequently had grade 3 FL (35% versus 8%, respectively, P=.006). Patients who underwent alloSCT received more prior therapies (4 versus 3, respectively, P%26lt;.0001) and more often had resistant disease at SCT (19% versus 6%, respectively, P=.008). Cumulative 100-day nonrelapse mortality (NRM) for autoSCT and alloSCT were 1% and 6%, respectively (P%26lt;.0001), whereas 3-year NRM rates were 3% versus 24%, respectively (P%26lt;.0001). For autoSCT and alloSCT, cumulative rates of relapse, progression, and/or transformation were 32% versus 16%, respectively (P=.03), whereas 3-year overall survival rates were 87% versus 61% (P%26lt;.0001); there were no differences in failure-free survival. AlloSCT was associated with increased risk of death on multivariate analysis (hazard ratio=2.77, 95% confidence interval=1.46-5.26, P=.002). This finding persisted on propensity scoring/matching. Multivariate analysis for autoSCT patients identified age%26gt;60 years and%26gt;3 prior therapies as adverse factors. Furthermore, a survival model was created for the autoSCT cohort based on number of factors present (0, 1, 2); 3-year failure-free survival was 72%, 47%, and 20%, respectively (P=.0003), and 3-year overall survival was 96%, 82%, and 62%, respectively (P%26lt;.0001). %26lt;br%26gt;CONCLUSIONSAutoSCT remains an effective therapy for patients with FL. For alloSCT, continued strategies to reduce NRM are needed. Cancer 2013;119:3662-3671.

• 出版日期2013-10-15
• 单位西北大学