Comparison of Autologous Vs. Allogeneic Stem Cell Transplantation for Non-Hodgkin Lymphoma

Stem cell transplantation (SCT) is a common indication for patients with Non-Hodgkin lymphoma (NHL). Auto-SCT is recommended for patients with relapsed NHL or as consolidative therapy in first remission. Allo-SCT is reserved for pts with either relapsed or primary refractory disease. The outcomes of these pts in large prospective studies are lacking and current recommendations and timing of selection of auto vs. allo-SCT are influenced by variety of factors including physician bias. Transplant outcomes of auto or allo-SCT have not been elucidated as a single cohort.

We report a retrospective analysis of 270 pts with NHL who underwent auto-SCT or allo-SCT between January 2000- December 2010 after obtaining institutional IRB approval. Data were analyzed using SPSS.19.

Of the 270 pts, 238 patients underwent SCT for B-cell lymphoma (178 auto, 60 allo-SCT), and 32 for T-cell lymphoma (21 auto and 11 allo-SCT). Fifteen pts (6%) received prior auto-SCT. The median age of transplant was 52 years for the entire group. For those who underwent allo-SCT, median age was 47 (range 22–65 yrs) and 54 yrs (range 22–77) for auto-SCT. One hundred seventy (62%) were male. Majority of pts (76%) had advanced stage disease (stages III and IV). Fifty four (20%) received radiation therapy either before or after transplantation. The median number of prior regimens for allo-SCT were 3 (range 1–5) and 2 for auto-SCT (range 1 to 4). Within the allo-SCT group (n=71), 45 received matched-related donor transplants, and 26 unrelated donor transplants; majority of pts (n=47) received reduced intensity conditioning regimen. The auto-SCT group predominantly received CBV as their conditioning regimen. Median time from diagnosis to allo-SCT or auto-SCT was 1.4 yrs (range 0.32–13.1 yrs) and 1.69 (range 0.38–13.7 yrs), respectively. The median follow up time for the entire cohort was 6.2 yrs. The overall survival (OS) rates for the B- cell and T-cell NHL were 58% and 50% respectively (allo-SCT 51% vs. 54% for B and T-cell NHL, and auto-SCT 60% vs. 47% for B and T-cell lymphoma, respectively) (p=0.26). Within the allo-SCT group the relapse and non-relapse mortalities were 45% and 16%, respectively. In the auto-SCT group, the relapse and non-relapse mortality were 46% and 7% respectively. In B-cell lymphoma the relapse rate was 48% and 45% for auto and allo-SCT respectively (p=0.80). In T-cell lymphoma the relapse rate was 40% and 45% for auto and allo-SCT (p=0.67). Multivariate analysis of pts receiving auto vs. allo-SCT in NHL will be presented.

We conclude that in this highly selected patient population with otherwise minimal comorbidities but chemo-sensitive aggressive lymphomas, about 50% of patients achieve long term survival after either an auto or allo-SCT approach. Despite recent evidence, there are intricate difficulties in patient selection for allo vs. auto-SCT and outcome of either approach is not satisfactory. Post transplant relapse is the most common cause of post-SCT failure. Tandem auto followed by allo-SCT and maintenance strategies need to be explored. We propose a larger prospective analysis on transplant outcomes in both B and T-cell lymphoma and improve strategies to prevent relapses after SCT.

No relevant conflicts of interest to declare.