Abstract
Early disease progression at 2 years after first-line immunochemotherapy has unclear optimal second-line therapeutic choices. This retrospective study (n = 17) analyzed clinical outcomes when autologous stem-cell transplantation was considered up front at first relapse in transplant-eligible follicular lymphoma patients with relapse within 24 months of first-line therapy. Overall survival was improved at 2 and 5 years.
Background: In Canadian adults, follicular lymphoma (FL) is the most common subtype of non-Hodgkin lymphomas. Approximately 20% of patients with FL experience progression of disease within 2 years of first-line chemoimmunotherapy. Those patients have an expected overall survival of less than 5 years. The optimal second-line treatment for these high-risk patients is unclear. Patients and Methods: We analyzed data from the Blood and Bone Marrow Transplantation Center at Ottawa Hospital to determine whether autologous stem-cell transplantation as up-front therapy for first relapse can improve outcomes in this high-risk FL subgroup. We identified 17 patients who underwent up-front autologous stem-cell transplantation between February 2012 and February 2019.Results: The disease of all patients had relapsed within 24 months after receipt of their first rituximab-based chemotherapy. Overall survival at 2 and 5 years was 86.2% (95% confidence interval [CI], 55-96) and 71.8% (95% CI, 31-91), respectively. The progression-free survival at 2 and 5 years was 62.6% (95% CI, 35-81) and 53.6% (95% CI, 25-75), respectively. Conclusion: Overall survival is improved when receiving autologous hematopoietic stem-cell transplantation as upfront therapy at first relapse in transplant-eligible FL whose disease relapses within 24 months of first-line therapy. Data from our single center look promising, but the data need to be replicated with a larger sample size. (C) 2020 Elsevier Inc. All rights reserved.