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Autologous stem cell transplantation improved follicular lymphoma outcomes
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Autologous stem cell transplantation was associated with better survival outcomes than rituximab-containing regimens in a cohort of patients with follicular lymphoma, according to results of a multicenter study.
Allogeneic transplantation, however, was not associated with improved survival.
The investigators aimed to determine whether autologous or allogeneic stem cell transplantation is optimal for patients with transformed follicular lymphoma, and whether either type of transplantation improved outcomes compared with rituximab (Rituxan, Genentech/Idec Pharmaceuticals)-containing chemotherapy alone.
OS served as the primary endpoint.
There were 97 patients in the autologous cohort, 22 patients in the allogeneic cohort and 53 who were treated with rituximab regimens.
After transformation, 5-year OS was 65% in the autologous group, 46% in the allogeneic group and 61% in the rituximab group (P=.24).
Five-year PFS rates were 55% for autologous stem cell transplantation, 46% for allogeneic transplant and 40% for rituximab (P=.12).
Multivariable analysis results indicated that autologous transplantation was associated with improvements in OS compared with rituximab (HR=0.13; 95% CI, 0.05-0.34). However, researchers did not observe similar improvement when they compared of allogeneic transplantation with rituximab (HR=0.44; 95% CI, 0.16-1.24).
Similar OS and PFS outcomes were observed in both stem cell transplantation groups.
The 5-year transplantation-related mortality rate was 5% in the autologous group and 23% in the allogeneic group.
Perspective
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Ajay K. Gopal, MD, FACP
The study by Villa and colleagues supports the common practice of offering autologous transplant consolidation to patients with transformed follicular lymphoma, suggesting a PFS advantage over rituximab chemotherapy alone.
However, it is important to note — as pointed out by the authors — that many imbalances may not have been accounted for in this retrospective comparison.
For example, compared with patients who only received rituximab, one would expect transplant patients to generally be younger, fitter and have chemosensitive disease, all factors that should lead to improved outcomes. The study also excluded patients concurrently diagnosed with follicular and diffuse large B-cell lymphoma, so these data should not be applied to this clinical scenario. Nevertheless, this study supports the use of autologous transplant in selected patients with transformation of follicular lymphoma.
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