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Autologous Transplantation (autoHCT) is Associated with Improved Overall Survival (OS) in Follicular Lymphoma (FL) Patients (Pts) Experiencing Early Therapy Failure after Frontline Chemo-Immunotherapy: A National Lymphocare Study (NLCS) & CIBMTR Analysis

Year: 2017

Type: article

Abstract: Introduction: FL pts experiencing therapy failure within 2 years (yrs) of a frontline rituximab-based chemoimmunotherapy have poor OS regardless of the type of therapy or rituximab maintenance use. A recent NLCS reported 5-yr OS of only 50% in FL pts experiencing early therapy failure, compared to 90% survival in pts not progressing within 2-yrs of frontline chemoimmunotherapy (Casulo C. JCO 2015). Whether autoHCT can improve outcomes of this high-risk subgroup of FL pts is not known. Methods: In this study, early therapy failure (ETF) was defined as failure to achieve at least a partial response (PR) after first line chemoimmunotherapy or disease relapse/progression within 2-yrs of starting first line chemoimmunotherapy. FL pts in the NLCS fulfilling these criteria and not receiving autoHCT represent the non-HCT cohort of this analysis (n = 174); while ETF FL pts undergoing autoHCT from the CIBMTR represent the autoHCT cohort (n = 175). All patients received rituximab-based chemoimmunotherapy as first line treatment. Age at FL diagnosis was restricted to 18-70 yrs, but there was no upper limit for age at autoHCT. FL pts with transformation were excluded. NLCS pts who died within 4 months of ETF were excluded (ie, pts not surviving long enough for salvage/autoHCT). Primary objective was OS; measured from date of ETF to death or last follow up (left truncated). Results: Baseline characteristics are shown in Table 1. The 3-yr OS of non-HCT and autoHCT cohorts was 60% versus 67% respectively (P = .16). On multivariate analysis (MVA) autoHCT in FL pts with ETF was not associated with a reduced risk of mortality (HR = .88, 95%CI:.61-1.26, P = .49). Only age ≥60 yrs predicted for a higher mortality risk (HR = 2.49, 95%CI: 1.18-5.25, P = .002). A planned subgroup analysis of non-HCT cohort (n = 174) versus subset of autoHCT cohort pts receiving early HCT (≤1-yr from the time of ETF; n = 123) showed higher 3-yr OS with autoHCT (60% versus 73%, P = .02). On MVA early application of autoHCT was associated with a significantly reduced risk of mortality (HR = .63, 95%CI: .42-.94, P = .02). Conclusion: This unique collaboration between NLCS and CIBMTR suggests that autoHCT when performed early (≤1-yr from therapy failure) in FL pts experiencing ETF after rituximab-based chemoimmunotherapy, is associated with an OS benefit. Prospective trials to confirm these findings are urgently needed.Tabled 1

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.096