Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure

Smith, Sonali M.; Godfrey, James; Ahn, Kwang Woo; DiGilio, Alyssa; Ahmed, Sairah; Agrawal, Vaibhav; Bachanová, Veronika; Bacher, Ulrike; Bashey, Asad; Bolaños-Meade, Javier; Cairo, Mitchell S.; Chen, Andy; Chhabra, Saurabh; Copelan, Edward A.; Dahi, Parastoo B.; Aljurf, Mahmoud; Farooq, Umar; Ganguly, Siddhartha; Hertzberg, Mark; Holmberg, Leona; Inwards, David J.; Kanate, Abraham S.; Karmali, Reem; Kenkre, Vaishalee P.; Kharfan‐Dabaja, Mohamed A.; Klein, Andreas K.; Lazarus, Hillard M.; Mei, Matthew; Mussetti, Alberto; Nishihori, Taiga; Geethakumari, Praveen Ramakrishnan; Saad, Ayman; Savani, Bipin N.; Schouten, Harry C.; Shah, Nirav N.; Urbano-Ispizúa, Álvaro; Vij, Ravi; Vose, Julie M.; Sureda, Anna; Hamadani, Mehdi

doi:10.1002/cncr.31374

Cited by 62 publications

(52 citation statements)

References 28 publications

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“…A “revival” of interest in autologous SCT has occurred focused on patients with early relapse. Several retrospective analyses have reported 5 year OS of 70% following autologous SCT in this patient population . Data generated from the Center for International Blood and Marrow Transplant Research and the National LymphoCare Study, suggests that patients with early treatment failure undergoing early autologous SCT had higher 5‐year OS than those without auto SCT (73% vs 60%) …”

Section: Treatment Of Relapsed Flmentioning

confidence: 88%

Follicular lymphoma: 2020 update on diagnosis and management

2019

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Disease overview: Follicular lymphoma (FL) is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. Follicular lymphoma is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal involvement is less common. Cytopenias are relatively common but constitutional symptoms of fever, night sweats, and weight loss are uncommon in the absence of transformation to diffuse large B cell lymphoma. Diagnosis:The diagnosis is based on histology from a biopsy of a lymph node or other affected tissue. Incisional biopsy is preferred over needle biopsies in order to give adequate tissue to assign grade and assess for transformation. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10 and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein.The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes.Risk stratification: The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age > 60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4. The presence of 0-1, 2, and ≥ 3 adverse factors defines low, intermediate, and high-risk disease. There are other clinical prognostic models but the FLIPI remains the most common. Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis.Regardless of the prognostic model used, modern therapies have demonstrably improved prognosis.Risk-adapted therapy: Observation continues to be appropriate for asymptomatic patients with low bulk disease and no cytopenias. There is no overall survival advantage for early treatment with either chemotherapy or single agent rituximab. For patients needing therapy, most patients are treated with chemoimmunotherapy, which has improved response rates, duration of response and overall survival (OS).Randomized studies have shown additional benefit for maintenance rituximab.Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL. Kinase inhibitors, other immunotherapies, and stem cell transplantation (SCT) are also considered for recurrent disease.

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Section: Treatment Of Relapsed Flmentioning

confidence: 88%

Follicular lymphoma: 2020 update on diagnosis and management

2019

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“…Those undergoing MSD allogeneic transplantation had lower relapse rates than those undergoing ASCT (73% vs 70%) and similar OS, but increased nonrelapse mortality (5% vs 17%). 38 This may be an option for patients with extensive bone marrow involvement precluding use of ASCT or relapse after ASCT.…”

Section: Is the Patient A Candidate For A Clinical Trial?mentioning

confidence: 99%

How I treat early-relapsing follicular lymphoma

Casulo

Barr

2019

Blood

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Follicular lymphoma (FL) is the most frequently occurring indolent non-Hodgkin lymphoma, with generally favorable outcomes but a variable clinical course. Recent studies have elucidated the consistent and reproducible frequency of early disease progression in FL, occurring in ∼20% of patients. Relapse of FL within 24 months of chemoimmunotherapy (POD24) is now established as a robust marker of poor survival, leading to increased risk of death. Currently, there is no established method of identifying patients at risk for early disease progression at the time of their FL diagnosis. However, numerous studies worldwide are investigating clinical, pathologic, and radiographic biomarkers to help predict POD24, thereby improving subsequent outcomes and adapting therapy based on individual risk. There is also a paucity of standardized treatments for patients with POD24, but investigations are ongoing testing novel targeted therapies and autologous stem cell transplantation strategies. This review provides an overview of early-relapsing FL and our approach to patient management based on recent available data.

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“…The 5‐year adjusted probability of NRM was significantly lower for auto‐HCT (5%) vs MSD (17%) or MUD HCT (33%; P < 0.0001). The 5‐year adjusted probability of disease relapse was lower with MSD (31%) or MUD HCT (23%) vs auto‐HCT (58%; P < 0.0001) …”

Section: High‐risk Fl: Can Registry Data Inform Decision Making?mentioning

confidence: 96%

Advances in transplantation for lymphomas resulting from CIBMTR lymphoma working committee's research portfolio: A five-year report (2013-2018)

Hamadani

2018

Adv Cell Gene Ther

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The Center for International Blood and Marrow Transplant Research (CIBMTR) is a research collaboration between the National Marrow Donor Program (NMDP)/Be The Match and the Medical College of Wisconsin (MCW). The CIBMTR collaborates with the global scientific community to advance hematopoietic cell transplantation (HCT) and cellular therapy worldwide to increase survival and enrich quality of life for patients. The observation research program within CIBMTR is organized into 15 working committees. This review is aiming to highlight the observational research studies published by the CIBMTR Lymphoma Working committee over the last 5 years (2013-18) and to summarize how these studies have impacted the field by helping inform clinical practice in scenarios where prospective data from high quality randomized trials were not available or where owing to the rarity of a particular transplant indication such data were unlikely to be generated, outside the setting of a large observational research database. The salient findings reviewed include; (a) studies supporting role of autologous HCT in diffuse large B-cell lymphoma (DLBCL) patients with sensitive relapse of disease within 1 year of diagnosis, (b) role of autologous HCT vs allogeneic HCT in follicular lymphoma patients with early therapy failure, (c) prognostic scoring system development for classical Hodgkin lymphoma and DLBCL patients with prior autograft failure, (d) defining the role of alternative donor transplantation in lymphomas, (e) evaluating appropriate conditioning regimens for HCT in lymphoma, and (f) outcomes of HCT in rare lymphoid malignancies.

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Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure

Abstract: Patients with high-risk FL, as defined by ETF, undergoing auto-HCT for FL have low NRM and a promising 5-year OS rate (70%). MSD HCT has lower relapse rates than auto-HCT but similar OS. Cancer 2018;124:2541-51. © 2018 American Cancer Society.

Cited by 62 publications

References 28 publications

Follicular lymphoma: 2020 update on diagnosis and management

Follicular lymphoma: 2020 update on diagnosis and management

How I treat early-relapsing follicular lymphoma

Advances in transplantation for lymphomas resulting from CIBMTR lymphoma working committee's research portfolio: A five-year report (2013-2018)

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