High-dose radioimmunotherapy versus conventional high-dose therapy and autologous hematopoietic stem cell transplantation for relapsed follicular non-Hodgkin lymphoma: a multivariable cohort analysis

• Published in: Blood Vol. 102; no. 7; pp. 2351 - 2357
• Main Authors: Gopal, Ajay K., Gooley, Theodore A., Maloney, David G., Petersdorf, Stephen H., Eary, Janet F., Rajendran, Joseph G., Bush, Sharon A., Durack, Lawrence D., Golden, Jane, Martin, Paul J., Matthews, Dana C., Appelbaum, Frederick R., Bernstein, Irwin D., Press, Oliver W.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.10.2003; The Americain Society of Hematology
• Subjects: Adult; Antigens, CD20 - immunology; Antineoplastic agents; Biological and medical sciences; Cohort Studies; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease Progression; Dose-Response Relationship, Radiation; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Humans; Iodine Radioisotopes - therapeutic use; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Follicular - mortality; Lymphoma, Follicular - radiotherapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - radiotherapy; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - radiotherapy; Pharmacology. Drug treatments; Radioimmunotherapy - adverse effects; Radioimmunotherapy - methods; Survival Rate; Treatment Outcome; Antineoplastic agent; Human; Relapse; Stem cell; Hematopoietic cell; Malignant hemopathy; Non Hodgkin lymphoma; Radiotherapy; Autograft; Chemotherapy; Treatment; Lymphoproliferative syndrome; Immunoradiotherapy; Follicular lymphoma; Graft; Therapeutic protocol; Comparative study
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2003-02-0622

We performed a multivariable comparison of 125 consecutive patients with follicular lymphoma (FL) treated at our centers with either high-dose radioimmunotherapy (HD-RIT) using 131I-anti-CD20 (n = 27) or conventional high-dose therapy (C-HDT) (n = 98) and autologous hematopoietic stem cell transplantation. The groups were similar, although more patients treated with HD-RIT had an elevated pretransplantation level of lactate dehydrogenase (41% versus 20%, P = .03) and elevated international prognostic score (41% versus 19%, P = .02). Patients treated with HD-RIT received individualized therapeutic doses of 131I-tositumomab (median, 19.7 GBq [531 mCi]) to deliver 17 to 31 Gy (median, 27 Gy) to critical organs. Patients treated with C-HDT received total body irradiation plus chemotherapy (70%) or chemotherapy alone (30%). Patients treated with HD-RIT experienced improved overall survival (OS) (unadjusted hazard ratio [HR] for death = 0.4 [95% confidence interval (95% CI), 0.2-0.9], P = .02; adjusted HR, 0.3, P = .004) and progression-free survival (PFS) (unadjusted HR = .6 [95% C.I., 0.3-1.0], P = .06; adjusted HR, 0.5, P = .03) versus patients treated with C-HDT. The estimated 5-year OS and PFS were 67% and 48%, respectively, for HD-RIT and 53% and 29%, respectively, for C-HDT. One hundred-day treatment-related mortality was 3.7% in the HD-RIT group and 11% in the C-HDT group. The probability of secondary myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) was estimated to be .076 at 8 years in the HD-RIT group and .086 at 7 years in the C-HDT group. HD-RIT may improve outcomes versus C-HDT in patients with relapsed FL. (Blood. 2003;102:2351-2357)