Outcome Comparison of Allogeneic versus Autologous Stem Cell Transplantation in Transformed Low-Grade Lymphoid Malignancies: A Systematic Review and Pooled Analysis of Comparative Studies

Abstract

Background: Some patientswith low-grade lymphoid malignancies develop transformed disease, requiring stem cell transplantation (SCT). SCT outcomes in transformed low-grade lymphoid malignancies may differ from those of nontransformed disease or other aggressive non-Hodgkin lymphomas. We conducted a pooled analysis of the clinical outcomes of allogeneic versus high-dose therapy (HDT) with autologous SCT in adult patients with transformed low-grade lymphoid malignancies. Methods: A PubMed, EMBASE, and Cochrane search yielded 4 comparative studies reporting allogeneic versus HDT with autologous SCT outcomes in adults (age ≥18) with transformed low-grade lymphoid malignancies, including follicular, chronic/small lymphocytic, and marginal zone lymphoma. Risk ratio (RR) and 95% CI were calculated using random-effects models. Results: Rates for overall survival (OS) were 51.0 versus 69.5% (RR = 1.55, 95% CI 1.19-2.02, p = 0.001), rates of relapse were 37.3 versus 35.3% (RR = 1.04, 95% CI 0.70-1.55, p = 0.84), and rates of transplant-related mortality (TRM) were 33.3 versus 7.2% (RR = 4.52, 95% CI 2.75-7.43, p < 0.00001) for allogeneic versus autologous SCT. Previous rituximab treatment, reduced intensity conditioning regimen prior to SCT, or original pathology had no prognostic impact. Conclusion: HDT followed by autologous SCT was associated with lower TRM and a better OS, but there was no difference in relapse versus allogeneic SCT. Autologous SCT may be the better therapeutic option, considering the second chance of allogeneic SCT in the case of relapse.

Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis

“…However, in terms of clinical outcome, the response of allogeneic therapy for nonresponsive FCGS appears to be delayed as compared to autologous ASC treatment. No direct comparison to other studies is possible; however, other studies also demonstrated improved outcome when using an autologous cell source as compared to allogeneic . This delayed response has practical implications when performing a clinical trial in a debilitating and painful disease, such as FCGS, as cat‐owner satisfaction and compliance depend on response to therapy.…”

<p>Immunochemotherapy for Richter syndrome: current insights</p>

“…In contrast, there are no established standards of care for patients with clonally related DLBCL-RS, and a clinical trial should thus always be considered. If a clinical trial is unavailable, the most appropriate therapeutic interventions currently appear to be induction treatment with immunochemotherapy followed by postremission consolidation with allogeneic or (if not feasible) autologous hematopoietic stem cell transplantation (HSCT) 18,72,73. In a large retrospective analysis of the European Group for Blood and Marrow Transplantation, the median OS, relapse-free survival, and the cumulative incidences of relapse and nonrelapse mortality at 3 years for patients with RS undergoing allogeneic HSCT were 36%, 27%, 47%, and 26%, respectively, while they were 59%, 45%, 43%, and 12%, respectively, for RS patients undergoing autologous HSCT 73…”

A Review of Autologous Stem Cell Transplantation in Lymphoma

“…Patients with chemotherapy sensitive disease who achieved a CR with ASCT had an 84% 4-year survival compared to 44% with patients who had partial response (PR). There are several trials that continue to evaluate the role of ASCT or allo-SCT [13,14] as well as tandem transplantation [15] for aggressive lymphoma. In a study by Taverna and colleagues (2016) relapse prevention strategies after ASCT consolidation were reviewed in great detail [16].…”