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. 2018 Jun;24(6):1163-1171.
doi: 10.1016/j.bbmt.2017.12.771. Epub 2017 Dec 11.

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

Carla Casulo  1 , Jonathan W Friedberg  1 , Kwang W Ahn  2 , Christopher Flowers  3 , Alyssa DiGilio  4 , Sonali M Smith  5 , Sairah Ahmed  6 , David Inwards  7 , Mahmoud Aljurf  8 , Andy I Chen  9 , Hannah Choe  10 , Jonathon Cohen  3 , Edward Copelan  11 , Umar Farooq  12 , Timothy S Fenske  13 , Cesar Freytes  14 , Sameh Gaballa  15 , Siddhartha Ganguly  16 , Yogesh Jethava  17 , Rammurti T Kamble  18 , Vaishalee P Kenkre  19 , Hillard Lazarus  20 , Aleksandr Lazaryan  21 , Richard F Olsson  22 , Andrew R Rezvani  23 , David Rizzieri  24 , Sachiko Seo  25 , Gunjan L Shah  26 , Nina Shah  6 , Melham Solh  27 , Anna Sureda  28 , Basem William  29 , Aaron Cumpston  30 , Andrew D Zelenetz  26 , Brian K Link  13 , Mehdi Hamadani  31
Affiliations

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

Carla Casulo et al. Biol Blood Marrow Transplant. 2018 Jun.

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.

Keywords: Autologous transplantation; Chemoimmunotherapy; Early therapy failure; Early transplant; Follicular lymphoma; Rituximab.

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Conflict of interest statement

Disclosure of conflict of interest: No disclosures to report.

Figures

Figure 1a and 1b
Figure 1a and 1b. CONSORT Diagram for NCLS cohort and CIBMT cohort
Figure 1a. CONSORT Diagram National Lymphocare Study patients (non-auto-HCT cohort) Figure 1b. CONSORT Diagram CIBMTR patients (auto-HCT cohort)
Figure 1a and 1b
Figure 1a and 1b. CONSORT Diagram for NCLS cohort and CIBMT cohort
Figure 1a. CONSORT Diagram National Lymphocare Study patients (non-auto-HCT cohort) Figure 1b. CONSORT Diagram CIBMTR patients (auto-HCT cohort)
Figure 2
Figure 2
Overall Survival for non-autoHCT cohort vs. autoHCT cohort patients receiving HCT within 1 year of ETF.
See this image and copyright information in PMC

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