Evaluating upfront high-dose consolidation after R-CHOP for follicular lymphoma by clinical and genetic risk models
Year: 2020
Type: article
Abstract: High-dose therapy and autologous stem cell transplantation (HDT/ASCT) is an effective salvage treatment for eligible patients with follicular lymphoma (FL) and early progression of disease (POD). Since the introduction of rituximab, HDT/ASCT is no longer recommended in first remission. We here explored whether consolidative HDT/ASCT improved survival in defined subgroups of previously untreated patients. We report survival analyses of 431 patients who received frontline rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for advanced FL, and were randomized to receive consolidative HDT/ASCT. We performed targeted genotyping of 157 diagnostic biopsies, and calculated genotype-based risk scores. HDT/ASCT improved failure-free survival (FFS; hazard ratio [HR], 0.8, P = .07; as-treated: HR, 0.7, P = .04), but not overall survival (OS; HR, 1.3, P = .27; as-treated: HR, 1.4, P = .13). High-risk cohorts identified by FL International Prognostic Index (FLIPI), and the clinicogenetic risk models m7-FLIPI and POD within 24 months-prognostic index (POD24-PI) comprised 27%, 18%, and 22% of patients. HDT/ASCT did not significantly prolong FFS in high-risk patients as defined by FLIPI (HR, 0.9; P = .56), m7-FLIPI (HR, 0.9; P = .91), and POD24-PI (HR, 0.8; P = .60). Similarly, OS was not significantly improved. Finally, we used a machine-learning approach to predict benefit from HDT/ASCT by genotypes. Patients predicted to benefit from HDT/ASCT had longer FFS with HDT/ASCT (HR, 0.4; P = .03), but OS did not reach statistical significance. Thus, consolidative HDT/ASCT after frontline R-CHOP did not improve OS in unselected FL patients and subgroups selected by genotype-based risk models.
Source: Blood Advances
Authors: Stefan Alig, Vindi Jurinovic, Mohammad Shahrokh Esfahani, Sarah Haebe, Verena Passerini, Johannes C. Hellmuth, Erik Gaitzsch, William Keay, Natyra Tahiri, Anna Zoellner, Andreas Rosenwald, Wolfram Klapper, Harald Stein, Alfred Feller, German Ott, Annette M. Staiger, Heike Horn, Martin L. Hansmann, Christiane Pott, Michael Unterhalt, Christian Schmidt, Martin Dreyling, Ash A. Alizadeh, Wolfgang Hiddemann, Eva Hoster, Oliver Weigert
Institutions: LMU Klinikum, Stanford Medicine, Ludwig-Maximilians-Universität München, Stanford University, University of Würzburg, Comprehensive Cancer Center Mainfranken, University Hospital Schleswig-Holstein, Pathodiagnostik Berlin, University of Lübeck, Robert Bosch Hospital, Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, University of Tübingen, Goethe University Frankfurt, German Cancer Research Center, Deutsches Konsortium für Translationale Krebsforschung
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W3085442011