Autologous and Allogeneic Stem-Cell Transplantation for Transformed Follicular Lymphoma: A Report of the Canadian Blood and Marrow Transplant Group

作者：Villa Diego^*; Crump Michael; Panzarella Tony; Savage Kerry J; Toze Cynthia L; Stewart Douglas A; MacDonald David A; Buckstein Rena; Lee Christina; Alzahrani Mohsen; Rubinger Morel; Foley Ronan; Xenocostas Anargyros; Sabloff Mitchell; Muccilli Alexandra; Chua Neil; Couture Felix; Larouche Jean Francois; Cohen Sandra; Connors Joseph M; Ambler Kimberley; Al Tourah Abdulwahab; Ramadan Khaled M; Kuruvilla John

来源：Journal of Clinical Oncology, 2013, 31(9): 1164-1171.

DOI：10.1200/JCO.2012.44.0693

Purpose
To determine whether autologous (auto) or allogeneic (allo) stem-cell transplantation (SCT) improves outcome in patients with transformed follicular lymphoma compared with rituximab-containing chemotherapy alone.
Patients and Methods
This was a multicenter cohort study of patients with follicular lymphoma and subsequent biopsy-proven aggressive histology transformation. Patient, treatment, and outcome data were collected from each transplantation center and combined for analysis. A separate control group was composed of patients with transformation treated with rituximab-containing chemotherapy but not SCT. The primary end point was overall survival (OS) after transformation.
Results
One hundred seventy-two patients were identified: 22 (13%) treated with alloSCT, 97 (56%) with autoSCT, and 53 (31%) with rituximab-containing chemotherapy. Five-year OS after transformation was 46% for patients treated with alloSCT, 65% with autoSCT, and 61% with rituximab-containing chemotherapy (P = .24). Five-year progression-free survival (PFS) after transformation was 46% for those treated with alloSCT, 55% with autoSCT, and 40% with rituximab-containing chemotherapy (P = .12). In multivariate analysis, patients treated with autoSCT had improved OS compared with those who received rituximab-containing chemotherapy (hazard ratio [HR], 0.13; 95% CI, 0.05 to 0.34; P < .001). On the other hand, there was no OS difference between those treated with alloSCT and rituximab-containing chemotherapy (HR, 0.44; 95% CI, 0.16 to 1.24; P = .12). OS and PFS after SCT were similar between those treated with autoSCT and alloSCT. Five-year transplantation-related mortality was 23% for those treated with alloSCT and 5% for autoSCT.
Conclusion
Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity. J Clin Oncol 31:1164-1171.

• 出版日期2013-3-20