Abstract
7046 Background: The transformation of follicular lymphoma (FL) to high-grade histology occurs in up to 70% of patients (pts). 5yr overall survival (OS) and progression free survival (PFS) rates are 51% and 30% respectively for such patients undergoing autologous (Auto) stem cell transplantation (SCT) (William CD. JCO 2001). Studies comparing outcomes of Auto-SCT with allogeneic (Allo)-SCT in transformed FL have not been previously reported. Methods: FL pts with histologically confirmed transformation to diffuse large B-cell lymphoma undergoing SCT were eligible for this study. Patient characteristics were retrospectively collected. Results: 25 pts with transformed FL underwent SCT between 11/1991 and 7/2007 at our institution. The median age was 54yrs (range 44–68yrs). 17 pts underwent unpurged Auto-SCT. Stem cell source included peripheral blood (n=14), bone marrow (n=1) or both (n=2). Eight pts underwent Allo-SCT (HLA-identical sibling=5, matched unrelated donor=3). 2 Allo-SCT pts received reduced intensity conditioning. The Auto and Allo-SCT groups were matched for age, stage, LDH, number of prior therapies, time from diagnosis to transformation, chemosensitive disease and number of CD34+ cells infused (p-value>0.05). Median follow-up is 56 and 59 mos respectively for Auto and Allo-SCT. Rates of grade II-IV acute and chronic GVHD were 50% each in Allo-SCT group. PFS at 4-yrs by KM method for pts undergoing Auto and Allo-SCT is 23.8% and 56.3% respectively (p-value=0.23). OS at 4-yrs in similar order is 29.8% and 65.6% respectively (p-value=0.15). Cumulative incidence of relapse at 4-yrs was 14.2% and 65.2% respectively in Allo and Auto- SCT groups. 4yr non-relapse mortality rates were 23% and 25% (p-value=0.50) in similar order. Conclusion: Our limited, institutional experience suggests trends of improved PFS and OS in transformed FL pts undergoing Allo-SCT without significantly increased toxicity. Small numbers in our study likely contributed to lack of statistically significant PFS and OS difference between the two groups. These encouraging results warrant further investigation of allografting with matched donors in FL undergoing large cell transformation. No significant financial relationships to disclose.
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