Allogeneic Stem Cell Transplantation Is Associated with Long Term Disease Control in Chemo Sensitive Follicular Lymphoma Patients
Bibliographic record
Abstract
Abstract Abstract 2024 Introduction: Follicular lymphoma (FL) remains an incurable disease despite the use of immunochemotherapy or autologous stem cell transplant (ASCT). Allogeneic stem cell transplantation (Allo-SCT) remains a viable treatment option in FL because of its associated graft versus lymphoma effect and potential to achieve long term disease control. There is limited data in literature regarding long term outcome of follicular lymphoma post allo-SCT. Patients and Methods: We identified a total of 52 patients with chemosensitive FL underwent allo-SCT at our centre between 1989 and 2009. 89% were in a chemosensitive remission at time of transplantation. The conditioning regimens included BUCY in 48 (92%) patients. GVHD prophylaxis was cyclosporine and methotrexate until 2009 and subsequently cyclosporine and mycophenolate mofetil. Patients undergoing matched unrelated donor (MUD) transplant received alemtuzumab. Results: There were 30 (58%) males and 22 (42%) females. The median age at BMT was 45 years (range:24–64) and the median number of prior chemotherapy regimens was 3 (range: 1–6). Fifteen (29%) of patients had only received <3 prior lines of chemotherapy while 36 (69%) had received more than 3 or more lines of therapy at time of transplantation. Prior chemotherapy regimens included anthracyclines in 46 (88%), platinum in 25 (48%), chlorambucil in 25 (46%) and purine analogues in 15 (29%). Twenty three (44%) patients had received prior rituximab and 11 (21%) had received prior radiation therapy (RT). Three (6%) patients had prior ASCT. The median time from diagnosis to transplant was 35 months (range 6–148). All transplants were myeloablative except for one reduced intensity conditioning (RIC) transplant. Forty-five (87%) of patients received matched related donor transplant whereas 2 (4%) received matched unrelated donor (MUD) transplant with the remainder being mismatched donor transplants. The graft source was bone marrow in 35 (67%) and peripheral blood stem cells in 16 (31%). Grade 1–2 acute GVHD was seen in 58% and grade 3–4 in 12%. Chronic GVHD was observed in 50% patients. There was a statistically significant higher incidence of acute GVHD in those who received BM versus PBSC as the graft source although the incidence of cGVHD was not different. Three (6%) patients had relapsed at a median follow up of 68 months. The median time to relapse post-BMT was 54 months (range: 13 – 94). At a median follow up of 68 months (all patients) and 94 months (those who are alive); 34 (65%) patients are alive and well. None relapse mortality was 30%. The overall survival (OS) of entire cohort at 60 months was 70% (Fig-1) and PFS was 68%. Patients, who had achieved chemosensitivity pre transplant, had statistically significant PFS (p=0.04) and OS (p=0.02). In multivariate analysis, number of chemotherapy regimens (</=2) was associated with improved OS (p=0.05). Conclusions: In summary, myeloablative allo-SCT in younger patients with chemosensitive FL has excellent potential for long-term disease control. With a median follow-up in survivors of 94 months, the NRM remains reasonable. Given inferior results in multiply treated patients, future strategies should identify high risk groups that should be considered for allo-SCT based strategies. Disclosures: Gupta: Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".