Patients with follicular lymphoma (FL) experiencing therapy failure within 2 years of frontline rituximab-based therapy have better outcomes when they undergo autologous hematopoietic cell transplantation (HCT) early (≤1 year from therapy failure), according to research results presented at the BMT Tandem Meetings.
In this study, early therapy failure (ETF) was defined as failure to achieve at least a partial response after first-line chemoimmunotherapy or disease relapse/progression within 2-years of starting first line chemoimmunotherapy. Outcomes of patients not undergoing autologous HCT (n=174) and those undergoing autologous HCT (n=175) were reported to the CIBMTR® (Center for International Blood and Marrow Transplant Research®).
Age at FL diagnosis was restricted to 18-70 years, but there was no upper limit for age at autologous HCT. Median follow up was 71 months (range, 6-131) in patients undergoing autologous HCT and 76 months (range, <1-110) in non-transplanted patients.
A planned subgroup multivariate analysis of autologous HCT cohort patients receiving early HCT (≤1-year from the time of ETF; n=123) versus a non-HCT cohort (n=174) showed higher 3-year overall survival (OS) with autologous HCT (73% vs. 60%, respectively; p=0.02). The 3-year OS of non-HCT and autologous HCT cohorts was 60% vs. 67%, respectively (p=0.16).
In multivariate analysis, early use of autologous HCT was associated with a significantly reduced risk of mortality (HR=0.63, 95% CI: 0.42-0.94, p=0.02).
The researchers concluded that autologous HCT is associated with a significant OS benefit when performed early for patients with FL experiencing therapy failure in the first year after rituximab-based chemoimmunotherapy.