Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis

Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis

Transplantation and Cellular Therapy, December 2017

29242111

Carla Casulo, Jonathan W. Friedberg, Kwang W. Ahn, Christopher Flowers, Alyssa DiGilio, Sonali M. Smith, Sairah Ahmed, David Inwards, Mahmoud Aljurf, Andy I. Chen, Hannah Choe, Jonathon Cohen, Edward Copelan, Umar Farooq, Timothy S. Fenske, Cesar Freytes, Sameh Gaballa, Siddhartha Ganguly, Yogesh Jethava, Rammurti T. Kamble, Vaishalee P. Kenkre, Hillard Lazarus, Aleksandr Lazaryan, Richard F. Olsson, Andrew R. Rezvani, David Rizzieri, Sachiko Seo, Gunjan L. Shah, Nina Shah, Melham Solh, Anna Sureda, Basem William, Aaron Cumpston, Andrew D. Zelenetz, Brian K. Link, Mehdi Hamadani

Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within two years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup.ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within two years of frontline chemoimmunotherapy. We identified two groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT); and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment. 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in five year OS between the two groups (60% vs 67% respectively; p=0.16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1year of ETF; n=123) had higher five year OS than those without autoHCT (73% vs 60%, p=0.05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (HR=0.63, 95%CI:0.42-0.94, p=0.02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within one year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF.