Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 24, Issue 6, Pages 1163-1171Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2017.12.771
Keywords
Follicular lymphoma; Early therapy failure; Autologous transplantation; Early transplant; Rituximab; Chemoimmunotherapy
Categories
Funding
- Public Health Service from the National Cancer Institute [U24-CA076518]
- Public Health Service from the National Heart, Lung, and Blood Institute [U24-CA076518]
- Public Health Service from the National Institute of Allergy and Infectious Diseases [U24-CA076518]
- National Heart, Lung, and Blood Institute [5U10HL069294]
- National Cancer Institute [5U10HL069294]
- Health Resources and Services Administration [HHSH250201200016C]
- Actinium Pharmaceuticals
- Karyopharm Therapeutics
- Amgen, Inc.
- Ariad
- Be The Match Foundation
- Blue Cross
- Celgene Corporation
- Chimerix, Inc.
- Fred Hutchinson Cancer Research Center
- Fresenius-Biotech North America, Inc.
- Gamida Cell Teva Joint Venture Ltd.
- Genentech, Inc.
- Gentium SpA
- Genzyme Corporation
- GlaxoSmithKline
- Health Research, Inc.
- Roswell Park Cancer Institute
- HistoGenetics, Inc.
- Incyte Corporation
- Jeff Gordon Children's Foundation
- Kiadis Pharma
- Leukemia & Lymphoma Society
- Medac GmbH
- Medical College of Wisconsin
- Merck Co., Inc.
- Millennium: The Takeda Oncology Co.
- Milliman USA, Inc.
- Miltenyi Biotec
- National Marrow Donor Program
- Onyx Pharmaceuticals
- Optum Healthcare Solutions, Inc.
- Osiris Therapeutics
- Otsuka America Pharmaceutical, Inc.
- Perkin Elmer, Inc.
- Remedy Informatics
- Sanofi US
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix, Inc.
- St. Baldrick's Foundation
- StemCyte, A Global Cord Blood Therapeutics Co.
- Stemsoft Software, Inc.
- Swedish Orphan Biovitrum
- Tarix Pharmaceuticals
- TerumoBCT
- Teva Neuroscience, Inc.
- Therakos, Inc.
- University of Minnesota
- University of Utah
- WellPoint, Inc.
- Blue Shield Association
- Office of Naval Research [N00014-13-1-0039, N00014-14-1-0028]
- NATIONAL CANCER INSTITUTE [U24CA076518, P50CA097274, P30CA086862] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [U10HL069294] Funding Source: NIH RePORTER
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Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within 2 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 2 years of frontline chemoimmunotherapy. We identified 2 groups: the nonautoHCT 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 5-year OS between the 2 groups (60% versus 67%, respectively; P = .16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (<= 1 year of ETF; n = 123) had higher 5-year OS than those without autoHCT (73% versus 60%, P = .05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (hazard ratio, .63; 95% confidence interval, .42 to .94; P= .02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within 1 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. (C) 2017 American Society for Blood and Marrow Transplantation.
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