Durable Benefit of Rituximab Maintenance Post‐autograft in Patients With Relapsed Follicular Lymphoma: 12‐year Follow‐up of the Ebmt Lymphoma Working Party Lym1 Trial

Pettengell, Ruth; Uddin, Rahman; Boumendil, Ariane; Robinson, S; Smith, G. B.; Hawkins, Tim E.; Metzner, Bernd; Caballero, Marı́a Dolores; Tilly, Hervé; Romejko‐Jarosińska, Joanna; Bence‐Bruckler, Isabelle; To, Bik; Cu, Niemann; Kimby, Eva; Dreger, Peter; Schmitz, Norbert; Goldstone, AH; Montoto, Silvia

doi:10.1002/hon.2437_13

Cited by 7 publications

(9 citation statements)

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“…The fact that only 20 patients (11%) received planned rituximab therapy after autoHCT in the CIBMTR cohort, precludes us from assessing the impact of maintenance rituximab following autoHCT. Since rituximab maintenance post autoHCT was not shown to improve OS in a randomized study 22,28 , it is unlikely that the infrequent use of rituximab maintenance in CIBMTR cohort would impact survival outcomes of current analysis.…”

Section: Discussionmentioning

confidence: 92%

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

Casulo

Friedberg

Ahn

et al. 2018

Biology of Blood and Marrow Transplantation

112

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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.

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Section: Discussionmentioning

confidence: 92%

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

Casulo

Friedberg

Ahn

et al. 2018

Biology of Blood and Marrow Transplantation

112

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“…The initial goal in patients with early relapse is to provide disease control, ideally inducing complete remission, given the association with improved outcomes after chemoimmunotherapy and consolidation stem cell transplantation. 31 With a demonstrated favorable adverse effect profile and suggestion of superior disease control, bendamustine-based therapy has become a commonly used induction strategy for FL patients with symptomatic advanced-stage disease. Compared with CHOP, a similar proportion of patients experience early disease progression, although this proportion is somewhat smaller when bendamustinebased therapy is combined with obinutuzumab.…”

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

confidence: 99%

“…This strategy can induce prolonged remissions in FL. 31,34 The observation of a plateau in PFS curves suggests cure in a subset, differentiating transplantation from other treatment modalities. Given the consideration of clinical trials and stem cell transplantation at this point in the treatment algorithm ( Figure 2), this is often an appropriate time for referral of patients to large academic institutions.…”

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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“…However, a relatively large number of patients relapse after ASCT, probably depending on the biological heterogeneity. Therefore, the relevance of ASCT as first‐line consolidation treatment in the management of patients remains controversial 1‐11 . MRD assessment is a very sensitive tool to detect asymptomatic occult disease in B‐cell lymphomas.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome in patients with follicular lymphoma following high‐dose therapy and autologous stem cell transplantation

Metzner

Pott

Müller

et al. 2021

European J of Haematology

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Objective To contribute data on long‐term outcome and potential curative impact of ASCT in FL, especially following HDT with the BEAM protocol (BCNU, etoposide, cytarabine and melphalan), given very limited data on this topic in the literature. Patients and methods Patients with FL (n = 76) were treated in our institution with HDT and ASCT. In the case of long‐term remission (≥8 years), peripheral blood was tested for minimal residual disease by t(14;18)‐ and IGH‐PCR, including the last follow‐up. Results 10‐year overall survival, progression‐free survival, and freedom from progression (FFP) after first‐line ASCT (n = 20) were 80%, 60%, and 69%, after second‐line ASCT (n = 48, following BEAM) 66%, 38%, and 41%, after third/fourth‐line ASCT (n = 8) 33%, 25%, and 25%, respectively. Prognostic factors for FFP were treatment line and FLIPI (Follicular Lymphoma International Prognostic Index). 10‐year FFP for second‐line ASCT and low‐risk FLIPI at relapse was 69%, intermediate‐risk 28%, and high‐risk 25% (P < .05). 26 patients developed sustained long‐term clinical and molecular remissions of up to 27 years. Conclusions Sustained long‐term clinical and molecular complete remissions up to 27 years can be achieved following ASCT (including HDT with BEAM in second treatment line), indicating a potential curative impact of ASCT in FL.

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Durable Benefit of Rituximab Maintenance Post‐autograft in Patients With Relapsed Follicular Lymphoma: 12‐year Follow‐up of the Ebmt Lymphoma Working Party Lym1 Trial

Cited by 7 publications

References 0 publications

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

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

How I treat early-relapsing follicular lymphoma

Long‐term outcome in patients with follicular lymphoma following high‐dose therapy and autologous stem cell transplantation

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