TY - JOUR
T1 - Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma
AU - Epperla, Narendranath
AU - Ahn, Kwang Woo
AU - Armand, Philippe
AU - Jaglowski, Samantha
AU - Ahmed, Sairah
AU - Kenkre, Vaishalee P.
AU - Savani, Bipin
AU - Jagasia, Madan
AU - Shah, Nirav N.
AU - Fenske, Timothy S.
AU - Sureda, Anna
AU - Smith, Sonali M.
AU - Hamadani, Mehdi
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2018/1
Y1 - 2018/1
N2 - Large, multicenter studies comparing commonly used reduced-intensity conditioning (RIC) approaches in follicular lymphoma (FL) have not been performed. Using the Center for International Blood and Marrow Transplant Research database, we report the outcomes of the 2 most commonly used RIC approaches, fludarabine and busulfan (Flu/Bu) versus fludarabine, cyclophosphamide, and rituximab (FCR) in FL patients. We evaluated 200 FL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received RIC with either Flu/Bu (n = 98) or FCR (n = 102) during 2008 to 2014. All patients received peripheral blood grafts, and graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor–based approaches. Median follow-up of survivors in the Flu/Bu and FCR groups was 48 months and 46 months, respectively. On univariate analysis in the Flu/Bu and FCR groups, the 3-year rates of nonrelapse mortality (11% versus 11%, P =.94), relapse/progression (18% versus 15%, P =.54), progression-free survival (PFS) (71% versus 74%, P =.65), and overall survival (OS) (73% versus 81%, P =.18) were not significantly different. On multivariate analysis no difference was seen between the FCR and Flu/Bu cohorts in terms of grades II to IV (relative risk [RR], 1.06; 95% confidence interval [CI],.59 to 1.93; P =.84) or grades III to IV (RR, 1.18; 95% CI,.47 to 2.99; P =.72) acute GVHD, nonrelapse mortality (RR,.83; 95% CI,.38 to 1.82; P =.64), relapse/progression (RR,.99; 95% CI,.49 to 1.98; P =.97), PFS (RR,.92; 95% CI,.55 to 1.54; P =.76), or OS (RR,.70; 95% CI,.40 to 1.23; P =.21) risk. However, RIC with FCR was associated with a significantly reduced chronic GVHD risk (RR,.52; 95% CI,.36 to.77; P =.001). RIC with either Flu/Bu or FCR in patients with FL undergoing allo-HCT provides excellent 3-year OS, with acceptable rates of nonrelapse mortality. FCR-based conditioning was associated with a lower risk of chronic GVHD.
AB - Large, multicenter studies comparing commonly used reduced-intensity conditioning (RIC) approaches in follicular lymphoma (FL) have not been performed. Using the Center for International Blood and Marrow Transplant Research database, we report the outcomes of the 2 most commonly used RIC approaches, fludarabine and busulfan (Flu/Bu) versus fludarabine, cyclophosphamide, and rituximab (FCR) in FL patients. We evaluated 200 FL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received RIC with either Flu/Bu (n = 98) or FCR (n = 102) during 2008 to 2014. All patients received peripheral blood grafts, and graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor–based approaches. Median follow-up of survivors in the Flu/Bu and FCR groups was 48 months and 46 months, respectively. On univariate analysis in the Flu/Bu and FCR groups, the 3-year rates of nonrelapse mortality (11% versus 11%, P =.94), relapse/progression (18% versus 15%, P =.54), progression-free survival (PFS) (71% versus 74%, P =.65), and overall survival (OS) (73% versus 81%, P =.18) were not significantly different. On multivariate analysis no difference was seen between the FCR and Flu/Bu cohorts in terms of grades II to IV (relative risk [RR], 1.06; 95% confidence interval [CI],.59 to 1.93; P =.84) or grades III to IV (RR, 1.18; 95% CI,.47 to 2.99; P =.72) acute GVHD, nonrelapse mortality (RR,.83; 95% CI,.38 to 1.82; P =.64), relapse/progression (RR,.99; 95% CI,.49 to 1.98; P =.97), PFS (RR,.92; 95% CI,.55 to 1.54; P =.76), or OS (RR,.70; 95% CI,.40 to 1.23; P =.21) risk. However, RIC with FCR was associated with a significantly reduced chronic GVHD risk (RR,.52; 95% CI,.36 to.77; P =.001). RIC with either Flu/Bu or FCR in patients with FL undergoing allo-HCT provides excellent 3-year OS, with acceptable rates of nonrelapse mortality. FCR-based conditioning was associated with a lower risk of chronic GVHD.
KW - Allogeneic HCT
KW - FCR
KW - Flu/Bu
KW - Follicular lymphoma
KW - Reduced-intensity conditioning
UR - http://www.scopus.com/inward/record.url?scp=85034849252&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034849252&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.10.011
DO - 10.1016/j.bbmt.2017.10.011
M3 - Article
C2 - 29032272
AN - SCOPUS:85034849252
SN - 1083-8791
VL - 24
SP - 78
EP - 85
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 1
ER -