Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment

Patients with follicular lymphoma (FL) who experience early therapy failure (ETF) within 2years of frontline immunochemotherapy have poor overall survival (OS). We analyzed the Grupo Espanol de Linfomas y Trasplantes de Medula sea registry to determine whether autologous stem cell transplantation (ASCT) is effective in this high-risk subgroup. Patients with non-transformed FL treated with rituximab were included in the analysis. ETF was defined as relapse/progression within 2years of starting first-line therapy. We identified two groups: the ETF cohort (n=52; 38 transplanted in second complete response [CR2] and 14 transplanted in second partial response [PR2]), and the non-ETF cohort (patients receiving ASCT in either CR2 [n=14] or PR2 [n=2], but who did not experience ETF following first-line therapy). There were no differences in 5-year progression-free survival (PFS) (49% vs 60%, respectively, P=0.49) nor in 5-year OS (81% vs 83%, respectively, P=0.8) between the ETF and non-ETF cohorts. Moreover, in the subgroup of patients who presented an interval from first relapse after primary treatment to ASCT of <1year, there were neither differences in terms of PFS (49% vs 66%, respectively, P=0.44) nor in OS (86% vs 85%, respectively, P=0.9) between both cohorts. Patients in the ETF cohort transplanted in CR showed a plateau in the PFS curves beyond 7years of follow-up, at 50%. Patients presenting ETF after frontline therapy lack standard therapeutic options. ASCT may be a curative option for ETF in patients who respond to rescue treatments and should be considered an early consolidation option.