Impact of the use of autologous stem cell transplantation at first relapse both in naive and previously rituximab exposed follicular lymphoma patients treated in the GELA/GOELAMS FL2000 study

Abstract

BackgroundWe analyzed detailed characteristics and salvage treatment in 175 follicular lymphoma patients from the FL2000 study who were in progression after first-line therapy with or without addition of rituximab to chemotherapy and interferon. Design and MethodsThe impact of using autologous stem cell transplantation and/or rituximab administration at first progression was investigated, taking into account initial therapy. With a median follow up of 31 months, 3-year event free and overall survival rates after progression were 50% (95%CI 42-58%) and 72% (95%CI 64-78%), respectively. ResultsThe 3-year event free rate of rituximab re-treated patients (n=112) was 52% (95%CI 41-62%) versus 40% (95%CI 24-55%) for those not receiving rituximab second line (n=53) (P=0.075). There was a significant difference in 3-year overall survival between patients receiving autologous stem cell transplantation and those not: 92% (95%CI 78-97%) versus 63% (95%CI 51-72%) (P=0.0003), respectively. In multivariate analysis, both autologous stem cell transplantation and period of progression/relapse affected event free and overall survival. ConclusionsRegardless of front-line rituximab exposure, this study supports incorporating autologous stem cell transplantation in the therapeutic approach at first relapse for follicular lymphoma patients.Key words: follicular lymphoma, autologous stem cell transplantation, rituximab.Citation: Le Gouill S, De Guibert S, Planche L, Brice P, Dupuis J, Cartron G, Van Hoof A, Casasnovas O, Gyan E, Tilly H, Fruchart C, Deconinck E, Fitoussi O, Gastaud L, Delwail V, Gabarre J, Gressin R, Blanc M, Foussard C, and Salles G on behalf of the GELA and the GOE-LAMS. Impact of the use of autologous stem cell transplantation at first relapse both in naïve and previously rituximab exposed follicular lymphoma patients treated in the GELA/GOELAMS FL2000 study . Haematologica 2011;96(8):1128-1135. doi:10.3324/haematol.2010 ©2011 Ferrata Storti Foundation. This is an open-access paper.Impact of the use of autologous stem cell transplantation at first relapse both in naïve and previously rituximab exposed follicular lymphoma patients treated in the GELA/GOELAMS FL2000 study

Indications for hematopoietic stem cell transplantation in patients with follicular lymphoma: a consensus project of the EBMT-Lymphoma Working Party

“…Moreover, it remains to be shown in FL if relapse after rituximab-containing first-line treatment is associated with a poorer prognosis than relapse after rituximab-free treatment 31 as seems to be the case with aggressive B-cell lymphoma. 32 The role of HDT-ASCR in patients with relapsed FL in the rituximab era is supported by the studies published by Sebban et al 33 and Le Gouill et al 34 Moreover, a recent EBMT study has demonstrated that rituximab does EBMT FL transplant consensus haematologica | 2013; 98 (7) 1017 Table 5. Statements for which no consensus was achieved.…”

Long-term follow up of the FL2000 study comparing CHVP-interferon to CHVP-interferon plus rituximab in follicular lymphoma

“…three-quarters (73%) as recently reported in FL2000 patients with treatment failure after first-line therapy) and also probably accounted for the limited difference in OS. 24 Concerning prognosis and within the limits of patient numbers, all potential prognostic factors were overridden by the strong predictive power of the FLIPI in the present cohort.…”

Myeloablative chemotherapy for chemo-sensitive recurrent follicular lymphoma: potential benefit in second relapse

“…Other series have confirmed the lack of a detrimental effect of prior rituximab before HDT for FL and have actually suggested that patients who receive both rituximab and HDT at relapse have a significantly better outcome than the remainder. 25,26 This is reassuring as the population of patients candidate for HDT-ASCR who are rituximab-naïve is shrinking and most patients proceeding to HDT/ASCT have already received rituximab.…”