Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis

Abstract

Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within 2 years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup. ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within 2 years of frontline chemoimmunotherapy. We identified 2 groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT) and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment; 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in 5-year OS between the 2 groups (60% versus 67%, respectively; P = .16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1 year of ETF; n = 123) had higher 5-year OS than those without autoHCT (73% versus 60%, P = .05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (hazard ratio, .63; 95% confidence interval, .42 to .94; P = .02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within 1 year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF.

Clinical characteristics and outcomes of relapsed follicular lymphoma after autologous stem cell transplantation in the rituximab era

“…These results confirmed the need for alternative therapeutic options for patients with early relapses after ASCT. The poor prognosis of early events was also confirmed after first‐line immunochemotherapy in FL patients . In our study, we did not find any correlation between patients who relapsed of FL within 24 months after first‐line therapy (POD24) and the patient outcomes after ASCT relapses (Figure S2).…”

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

“…These survival figures are provocatively higher than ones predicted by the NLCS, in which only a minority of patients (8 of 110) underwent HCT . These findings are consistent with a recent NLCS/CIBMTR analysis in which early auto‐HCT performed within 1 year of ETF improved OS in comparison with conventional chemotherapy in FL patients, and they collectively suggest that transplantation should be considered in this high‐risk group of patients with early relapse.…”

“…CIBMTR analysis in which early auto-HCT performed within 1 year of ETF improved OS in comparison with conventional chemotherapy in FL patients, 19 and they collectively suggest that transplantation should be considered in this high-risk group of patients with early relapse. Although our results are promising, there are potential confounding variables when we are comparing outcomes with those of the NLCS or other large FL series.…”

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

“…High‐dose chemotherapy with autologous hematopoietic stem cell transplantation (auto‐HSCT) can prolong PFS and OS and should be considered as consolidative therapy in early relapse . Few prospective data are available regarding HSCT in the era of modern therapies, and its role continues to be elucidated .…”