Clinical characteristics and outcomes of relapsed follicular lymphoma after autologous stem cell transplantation in the rituximab era

Abstract

High‐dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a therapeutic option for patients with relapsed follicular lymphoma (FL). The clinical characteristics and outcomes of FL relapse after ASCT in the rituximab era have not yet been fully elucidated. We retrospectively reviewed 414 FL patients treated with ASCT between 2000 and 2014 in four hematology departments. All patients received rituximab as a first‐line treatment. We specifically analyzed the clinical characteristics, treatment strategies at relapse, and outcomes of 95 patients (23%) who relapsed after ASCT. The patients (median age, 57 y) received a median of two lines of therapy (range, 2‐6) prior to ASCT, with 92% in complete response (CR) or partial response (PR) before ASCT. Histological transformation at relapse after ASCT was observed in 20% of the patients. Treatment at relapse after ASCT consisted of chemotherapy with or without rituximab (n = 45/90, 50%), targeted agents (18%), rituximab monotherapy (14%), or consolidation allogeneic transplantation after induction chemotherapy (12%) and radiotherapy (6%). After relapse, the median progression‐free survival (PFS) and overall survival (OS) were 1 year (95% CI, 0.541‐1.579) and 5.5 years (95% CI, 1.910‐9.099), respectively. In the multivariate analysis, histological transformation (HT) was associated with OS (P = .044; HR 2.439; 95% CI, 1.025‐5.806), and a high FLIPI score at relapse was associated with PFS (P = .028; HR 2.469; 95% CI, 1.104‐5.521). This retrospective study showed that the period of PFS of patients who relapsed after ASCT is short. A biopsy should be performed for these patients to document the HT. Our results indicate that new treatment strategies will need to be developed for these patients.

Age and lymphocyte/monocyte ratio as prognostic factors for autologous transplantation in the treatment of patients with follicular lymphoma

“…Importantly, in contrast to our findings or those of other studies, the authors did not observe long-term disease control or a potential plateau. 22 Our results were very similar to those of a single-center Polish study. 23 In 30 transplanted patients with FL, the 10-year PFS was 33% and OS was 60%.…”

“…Importantly, in contrast to our findings or those of other studies, the authors did not observe long-term disease control or a potential plateau. 22 …”

Clinical outcomes in patients relapsed/refractory after ≥2 prior lines of therapy for follicular lymphoma: a systematic literature review and meta-analysis

“…Of the 20 studies included in the analysis-set, 9 were single-arm clinical trials [21,24,[32][33][34][35][36][37][38], 9 were retrospective cohort studies [7,19,22,23,25,[39][40][41][42]] and 2 were prospective cohort studies [20,43]. Two of the single arm trials were Phase I dose escalation studies, whilst the rest were Phase II non-comparative trials.…”

Klinikai és biológiai prognosztikai tényezők vizsgálata follikuláris lymphomás betegek kezelése során

“…Az ASCT-t követő POD24 esetén az anaemia, a betegség stádiuma a relapszus idején, valamint a Tx előtt alkalmazott kezelési vonalak száma volt prognosztikus jelentőségű a PFS terén, míg a szövettani transzformáció, emelkedett B2-mikroglobulinszint, nagy rizikójú FLIPI a relapszus idején számítottak az OS prediktorainak. Hosszú távú hatást és "plató fázist" ebben a vizsgálatban nem határozták meg [31], ezzel szemben a mi vizsgálatunkban a plató fázis 98 hónap volt, kissé meghaladva a 8 évet. Egy lengyel, unicentrikus vizsgálat hasonló eredményekhez jutott, mint a mi vizsgálatunk.…”