Autologous transplant in follicular lymphoma after treatment failure

Carla Casulo of the Wilmont Cancer Institute and colleagues completed a multicenter study comparing outcomes in follicular lymphoma (FL) patients with early treatment failure after frontline rituximab-based chemotherapy, who received autologous stem cell transplant (SCT) and those who did not.  The study findings were published online on December 11, 2017, in Biology of Blood and Marrow Transplantation.

An earlier study by Casulo showed that patients with FL who have disease progression or do not achieve a partial response, within the first 2 years after treatment have a much worse survival prognosis. The goal of this study was to determine if high dose chemotherapy with autologous SCT will improve overall survival (OS) in patients who have early treatment failure. 

Patient Population

• N = 349 total patients
  • Non-SCT = 174 patients
  • SCT = 175 patients
• Median age: non-SCT = 55 years vs SCT = 53 years
• Median time from diagnosis to SCT = 23 months
• Complete remission (CR)/partial remission (PR) after frontline therapy: non-SCT = 67% vs SCT = 78%

Key Findings

• Five-year OS: non-SCT = 60% (95% CI, 52%-67%) vs SCT = 67% (95% CI, 60%-75%), P = 0.25
• SCT did not influence OS in multivariate analysis
  • OS SCT: HR = 0.88 (95% CI, 0.61-1.26), P = 0.49
• Age >60 years associated with decreased OS in multivariate analysis
  • Age >60 mortality: HR = 2.49 (95% CI, 1.18-5.25) P = 0.02
• Subgroup analysis of SCT within 1 year of treatment failure (early SCT)
  • Two-year OS: non-SCT = 76% (95% CI, 69%-82%) vs SCT = 84% (95% CI, 79%-90%), P = 0.011
  • Five-year OS: non-SCT = 60% (95% CI, 52%-67%) vs SCT = 73% (95% CI, 66%-81%), P = 0.05

The results of this study advocate consideration of autologous SCT for FL patients who have early treatment failure, following frontline rituximab-based chemotherapy. The analysis of SCT within the first year after treatment failure supports a survival advantage in this cohort of patients.