Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: A Follow-Up Study of 2 Randomized Trials from the German Low Grade Lymphoma Study Group

Abstract

Patients with follicular lymphoma (FL) and progression of disease (POD) within 24 months after frontline treatment (POD24) have poor overall survival (OS). The optimal salvage treatment for these patients is unknown. We assessed the role of high-dose therapy and autologous stem cell transplantation (ASCT) in transplant-eligible patients. We analyzed 162 patients with advanced-stage FL who had received frontline treatment within the GLSG1996 or GLSG2000 trials. All patients had POD at age ≤ 65 years and had not received a prior transplant. Second-line treatment was not specified by study protocols. Survival was calculated from time of second-line treatment. Eighteen patients (11%) progressed (n = 16) or died (n = 2) during cytoreductive second-line treatment (considered "cytoreduction failure"); none received ASCT, and their median second-line OS was <1 year. A total of 113 patients had POD24 (70%), whereas 49 had POD after 24 months (30%). Sixty-three patients without cytoreduction failure received ASCT (39%), and 81 received no transplant (50%). In patients with POD24, a significant survival benefit was associated with ASCT with a 5-year second-line progression-free survival for ASCT versus no transplant of 51% versus 19% (hazard ratio, .38; 95% confidence interval, .24 to .62; P < .0001) and a 5-year second-line OS of 77% versus 59% (hazard ratio, .54, 95% confidence interval, .30 to .95; P= .031). Thus, ASCT is an effective treatment option for transplant-eligible patients with high-risk FL as identified by POD24 and should be evaluated in prospective clinical trials.

How I treat early-relapsing follicular lymphoma

“…It too confirmed that ASCT resulted in significantly higher 5-year OS compared with not receiving ASCT (77% vs 46%). 37 Use of sibling-matched (MSD) or unrelated-donor allogeneic transplantation has also been studied but has expected toxicity. The CIBMTR separately evaluated unrelated-donor and MSD transplantation compared with ASCT in FL patients with POD24 or refractory disease.…”

The investigation and management of follicular lymphoma

“…Carmustine, etoposide, cytarabine, melphalan (BEAM) is the dominant conditioning regimen used (1808/3196 patients [56·6%] in the studies outlined; Table I). 1,100–104,113–116,121 Transplant‐related, non‐relapse mortality (NRM) is typically low, with 100‐day NRM of 1–2% and 1–3‐year NRM of approximately 3%. TBI‐based conditioning is associated with a higher NRM and a concerning 8–12% rate of secondary myeloid malignancies 1,100 .…”

Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs

“…Few prospective data are available regarding HSCT in the era of modern therapies, and its role continues to be elucidated . Retrospective data suggest that patients with POD24 benefit from auto‐HSCT (i.e., increased PFS and OS compared with those not receiving transplant) . A recent study compared auto‐HSCT with either matched‐sibling donor (MSD) or unrelated matched donor (UMD) allogeneic HSCT (allo‐HSCT) in patients with POD24 .…”