• E Klyuchnikov, U Bacher, K Woo Ahn, J Carreras, N M Kröger, P N Hari, G H Ku, E Ayala, A I Chen, Y-B Chen, J B Cohen, C O Freytes, R P Gale, R T Kamble, M A Kharfan-Dabaja, H M Lazarus, R Martino, A Mussetti, B N Savani, H C Schouten, S Z Usmani, P H Wiernik, B Wirk, S M Smith, A Sureda, and M Hamadani.
• Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
• Bone Marrow Transplant. 2016 Jan 1; 51 (1): 58-66.

AbstractGrade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.

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