Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma

Abstract

Autologous stem-cell transplantation (ASCT) has been used in follicular lymphoma (FL) to achieve durable responses in first remission or in the relapsed or refractory settings. Addition of rituximab to chemotherapy for FL has been shown to improve survival. The impact of prior therapy with rituximab upon the effectiveness of high-dose therapy (HDT) and ASCT in patients with FL is unknown. We retrospectively reviewed consecutive patients with FL who underwent HDT and ASCT. Patients were categorized according to prior therapy with rituximab. Outcomes were compared between groups in all patients and in a well-matched subset. In all 35 patients received prior rituximab and 71 rituximab-naive patients were analyzed. The rituximab-naive group had a median overall survival (OS) that was not reached during follow-up, with a median relapse-free (RFS) survival of 49.9 months. The prior rituximab group also did not reach median OS and had a median RFS of 24.6 months. Survivals were not significantly different in this group or in the well-matched subset. In conclusion, these results suggest that the use of rituximab-based regimens for the treatment of FL does not compromise the effectiveness of HDT and ASCT as a salvage strategy in patients with FL.

Autologous transplant for relapsed follicular lymphoma: impact of pre-transplant rituximab sensitivity

“…Post-transplant 3-year OS were similar in both groups[14]. Kang et al also showed similar OS post-ASCT in patients who had (N=35) or had not (N=71) received rituximab prior to transplant[16]. However, in our study, the difference in OS (and PFS) became clear once we separated the RS from RR patients.…”

SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma

“…Two retrospective studies [52,53] analyzed the outcomes of patients treated with autologous HSCT or chemotherapy or chemoimmunotherapy in patients progressed or relapsed FL. Other cohorts assessed the role of autologous HSCT in rituximab pretreated patients [37,[54][55][56][57][58][59]. The efficacy of rituximab prior to stem cell collection as in vivo purging has been tested by a randomized trial [60].…”

Genome-wide profiling of follicular lymphoma by array comparative genomic hybridization reveals prognostically significant DNA copy number imbalances

“…3 While management strategies have changed, advanced-stage FL remains an incurable disease using conventional therapies. 4 Approximately 85% of FL is associated with a specific balanced translocation, t(14;18)(q32;q21), that leads to overexpression of the antiapoptotic gene BCL2 due to its relocation in proximity to an IgH enhancer element. [5][6][7][8] This genetic abnormality alone, however, is unlikely to produce clinical FL, as BCL2-overexpressing transgenic mice do not develop lymphoma 9,10 and t(14;18)-bearing lymphocytes have been frequently demonstrated in healthy individuals.…”