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Lymphoma

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Bone Marrow Transplantation volume 51, pages 654–662 (2016)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry ‘DRST’. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2- and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatment-sensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽42 years should be preferred if available.

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Acknowledgements

We would like to thank Franziska Strehle, Helga Neidlinger and Karin Fuchs, who are the data managers of the DRST and to all local data managers of the participating transplant units. Last but not least, thanks to all local as well as reference pathologists for their valuable support of this study. The DRST is supported by grants from the Deutsche Krebshilfe eV, Deutsche Jose-Carreras Leukämie Stiftung eV, DKMS and Alfred and Angelika Gutermuth-Stiftung. This study is based on data provided by the German Registry for Stem Cell Transplantation.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital (UH) of Tübingen, Tubingen, Germany

    F Heinzelmann & A Müller

  2. Department of Internal Medicine II, UH of Tübinge,

    W Bethge

  3. n, Tubingen, Germany

    W Bethge

  4. Department of Bone Marrow Transplantation, UH of Essen, Essen, Germany

    D W Beelen & H Ottinger

  5. Department of Radiotherapy, UH of Essen, Essen, Germany

    M Engelhard

  6. Clinic for Stem Cell Transplantation, UH of Hamburg (UKE), Hamburg, Germany

    N Kröger

  7. Department of Medicine V, UH of Heidelberg, Heidelberg, Germany

    P Dreger

  8. Department of Hematology and Oncology, UH of Leipzig, Leipzig, Germany

    D Niederwieser

  9. Department of Hematology and Oncology, UH of Freiburg, Freiburg, Germany

    J Finke

  10. Department of Internal Medicine III, UH of Ulm, Ulm, Germany

    D Bunjes

  11. Department of Internal Medicine III, UH of Munich (LMU), Munich, Germany

    J Tischer

  12. Department of Hematology, Oncology and Clinical Immunology, UH of Düsseldorf, Dusseldorf, Germany

    G Kobbe

  13. Department of Hematology and Oncology, UH of Regensburg, Regensburg, Germany

    E Holler

  14. Department of Internal Medicine I, UH of Dresden, Dresden, Germany

    M Bornhäuser

  15. Department of Internal Medicine A, UH of Münster, Munster, Germany

    M Stelljes

  16. Department for Bone Marrow Transplantation, DKD HELIOS Clinic of Wiesbaden, Wiesbaden, Germany

    H Baurmann

  17. Data Processing Center, University of Würzburg, Wurzburg, Germany

    I Haubitz

  18. Institute of Clinical Transfusion Medicine and Immunogenetics,

    H Schrezenmeier

  19. , UH of Ulm, Ulm, Germany

    H Schrezenmeier

  20. ZKRD Ulm, Ulm, Germany

    C Müller

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  1. F Heinzelmann
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Correspondence to F Heinzelmann.

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Author contributions

FH and HO were involved in all aspects of planning, execution, data evaluation of the study and writing of the manuscript. IH performed the statistical analyses of our data. Dr C. Müller facilitated the contact with the local data managers of DRST in case of queries and supervised the quality of their answers. All other co-authors are program directors of the participating German transplant units and performed in person the data source validation of our data on chronic GvHD. All co-authors critically reviewed the manuscript and agreed with the presented data.

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Heinzelmann, F., Bethge, W., Beelen, D. et al. Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas. Bone Marrow Transplant 51, 654–662 (2016). https://doi.org/10.1038/bmt.2015.348

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