Hematopoietic stem cell transplantation for the management of follicular lymphoma

Figures & data

Table 1 Autologous hematopoietic stem cell transplantation for follicular lymphoma

Trial	Patients (n)	Preparatory regimen	Follow-up (years)	PFS/EFS (%)	OS (%)
Relapsed/recurrent disease/primary induction failure
Rohatiner^Citation28	121	Cy/TBI	9	48 at 10 y	54 at 10 y
Freedman^Citation29	153	Cy/TBI	5	42 at 8 y	66 at 8 y
Bierman^Citation30	100	TBI 77 Non-TBI 23	2.6	44 at 4 y	65 at 4 y
Apostolidis^Citation36	99	Cy/TBI	5.5	63 at 5 y	69 at 5 y
Cao^Citation37	49 (FLGL) 26 (FLCL) 17 (TFL)	TBI 60 Non-TBI 32	–	44 at 4 y 51 at 4 y 49 at 4 y	60 at 4 y 58 at 4 y 50 at 4 y
First remission (randomized)
Lenz^Citation32	240	HSCT chemo	4.2	65 at 5 y 33 at 5 y (P < 0.0001)	84 at 5 y overall
Gyan^Citation9	172	HSCT chemo	9	64 at 9 y 39 at 9 y (P = 0.004)	76 at 9 y 80 at 9 y (P = NS)
Sebban^Citation40	401	HSCT chemo	7.5	38 at 7 y 28 at 7 y (P = NS)	71 at 7 y 76 at 7 y (P = NS)
First remission and relapsed refractory
Montoto^Citation33	CR1 131 Beyond CR1 562	TBI-based 401 Chemo-based 289	10.3	27 at 15 y	47 at 15 y

Abbreviations: HSCT, hematopoietic stem cell transplantation; Cy/TBI, cyclophosphamide/total body irradiation; PFS, progression-free survival; EFS, event-free survival; OS, overall survival; FLGL, follicular low-grade lymphoma; FLCL, follicular large cell lymphoma; TFL, transformed follicular lymphoma; TBI total body irradiation; NS, not significant; CR, complete remission; y, years.

Table 2 Allogeneic hematopoietic stem cell transplantation for follicular lymphomas: Myeloablative conditioning regimen

Trial	N^a	Preparatory regimen	Follow-up (months)	EFS/PFS (%)	OS (%)	NRM (%)	Relapse (%)
van Besien^Citation26	113	TBI 84% Non-TBI 16%	25	49	49	40	16
Kuruvilla^Citation47	37	Bu/Cy	65	79	76	16	3

Table 3 Myeloablative allogeneic versus autologous hematopoietic stem cell transplantation

Trial	Preparatory regimen	N	Follow-up (months)	EFS/PFS (%)	OS (%)	NRM (%)	Relapse (%)
Van Besien^Citation19	Auto unpurged	597	41	31	55	8	58
	Auto purged	131	49	39	62	14	43
	Allo	176	36	45	51	30	21
Verdonck^Citation50	Auto	18a	–	22	same	0	83
	Allo	10a	41	68		3 patients	0
Hosing^Citation20	Auto	68	71	17	34	6	74
	Allo	44	53	45	49	34	19 (P = 0.003)
Stein^Citation46	Auto	36	–	71	56	–	–
	Allo	15	–	64 (P = 0.049)	15 (P = 0.012)	46	–
Ingram^Citation24	Auto	82	88	56	67	2	43
	Allo	44	34	58 (P = NS)	69 (P = NS)	20 (P = 0.001)	20 (P = 0.01)

a Included other low-grade histologies.

Abbreviations: Auto, autologous; allo, allogeneic; PFS, progression-free survival; EFS, event-free survival; OS, overall survival; NRM, nonrelapse mortality; TBI, total body irradiation; NS, not significant; Bu/Cy, busulfan/cyclophosphamide.

Table 4 Allogeneic hematopoietic stem cell transplantation for follicular lymphomas: Reduced intensity and/or nonmyeloablative conditioning regimen

Trial	N	Preparatory regimen	Follow-up (months)	EFS/PFS (%)	OS (%)	NRM (%)	Relapse (%)
Khouri^Citation25	47a	FCR	36	83	85	15	4
Morris^Citation57	41	FM/Campath	36	65	73	11	44
Kusumi^Citation56	45c	Various	24	83 sens 64 res	79	18	2
Robinson^Citation55	52c	Various	10	54	65	31	21
Rezvani^Citation52	62b	TBI ± Flu	37	43	52	23	14

Notes:

a Patients with follicular lymphoma;

b included patients with transformed follicular lymphoma;

c included other low grade histologies.

Abbreviations: FCR, fludarabine, cyclophosphamide, rituximab; FM, fludarabine/melphalan; PFS, progression-free survival; EFS, event-free survival; OS, overall survival; NRM, non-relapse mortality; TBI, total body irradiation; NS, not significant; HR, hazards ratio.

Table 5 Allogeneic hematopoietic stem cell transplantation for follicular lymphoma: Reduced intensity and/or nonmyeloablative versus myeloablative conditioning regimen

Trial	Na	Preparatory regimen	Follow-up (months)	EFS/PFS (%)	OS (%)	NRM (%)	Relapse (%)
Hari^Citation54	MA 120	Various	50	67	71	23	17
	RIC 88		35	55	62	23
				(P = 0.07)	(P = 0.15)	(P = NS)
Rodriguez^Citation53	MA 18	Cy/TBI or Bu/cy	69	50	56	38	19
	RIC 16	FM	20	49	68	28
				(P = 0.56)	(P = 0.83)	(P = 0.4)
Sorror^Citation60	MA 27	Cy/TBI or Bu/cy	61	HR MA versus	HR MA versus	–	–
	RIC 14	TBI ± Flu	44	RIC 3.16	RIC 2.02
				(P = 0.02)	(P = 0.07)
Avivi^Citation61	MA 44	various	38	43	47	37	same
	RIC 87		34	49	53	33
				(P = NS)	(P = NS)	(P = NS)

Notes:

a Patients with follicular lymphoma;

b included patients with transformed follicular lymphoma;

c included other low grade histologies.

Abbreviations: MA, myeloablative; RIC, reduced intensity conditioning; PFS, progression-free survival; EFS, event-free survival; OS, overall survival; NRM, nonrelapse mortality; NS, not significant; HR, hazards ratio; Cy/TBI, cyclophosphamide/total body irradiation; Bu/Cy, busulfan/cyclophosphamide; FM, fludarabine/melphalan; Flu, fludarabine.

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