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Autologous stem cell transplant fails to improve outcomes in double-hit lymphoma
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Consolidative autologous hematopoietic stem cell transplantation did not improve 3-year RFS or OS in patients with double-hit lymphoma who achieved first complete remission, according to results of a landmark analysis.
Double-hit lymphoma — defined as B-cell non-Hodgkin lymphoma with MYC and BCL2 or BCL6 rearrangements — is a highly aggressive variant of non-Hodgkin lymphoma associated with poor survival after disease relapse. High-intensity chemotherapy alone or followed by autologous HSCT have been explored as options to improve outcomes.
“A major dilemma for oncologists who treat this disease was whether or not to recommend the potentially harmful therapy of autologous stem cell transplantation to patients with this disease [as] a strategy to help keep them in remission,” Daniel J. Landsburg, MD, assistant professor of clinical medicine in the division of hematology/oncology at Perelman School of Medicine at University of Pennsylvania, said in a press release.
Landsburg and colleagues analyzed data from 159 patients from 19 academic centers who achieved complete remission following frontline chemotherapy with R-CHOP (rituximab [Rituxan; Genentech, Biogen], cyclophosphamide, doxorubicin, vincristine and prednisone) or other intensive therapy and who were fit for transplant. Sixty-two patients underwent autologous HSCT and 97 did not.
The researchers performed a landmark analysis, for which they defined time zero as 3 months after completion of frontline therapy.
Over a median follow-up of 26.5 months (range, 0.2-114.6), 80% of patients achieved 3-year RFS and 87% achieved 3-year OS.
Patients who underwent autologous HSCT vs. those who did not demonstrated similar rates of 3-year RFS (89% vs. 75%) or OS (85% vs. 91%).
Three-year RFS appeared inferior among patients who received R-CHOP compared with intensive therapy (56% vs. 88%; P = .002). However, 3-year RFS and OS did not significantly differ among patients who received R-CHOP or intensive therapy when analyzed by receipt of autologous HSCT.
Median OS following relapse was 8.6 months.
The only significant differences in patient characteristics observed between the nontransplant and transplant cohorts included age older than 60 years (49% vs. 29%), bone marrow involvement (33% vs. 19%) and prior indolent lymphoma (6% vs. 23%).
“Our result is not explained by the differences in patients’ overall health or disease features,” Landsburg said. “The transplant and nontransplant arms of this study were very well matched.”
Patients appeared to remain in remission after frontline therapy, regardless of receipt of transplant.
“In the absence of a large randomized controlled trial, which would be very challenging to carry out in this case, this is the best evidence we have, and it shows there is not clear benefit to these patients undergoing autologous HSCT,” Landsburg said. – by Melinda Stevens
Disclosures: Landsburg reports a consultant/advisory role and institution research funding from Curis. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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