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Autologous HSCT consolidation shows no benefit for certain patients with B-cell lymphomas
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Upfront autologous hematopoietic stem cell transplantation consolidation did not appear to benefit patients with aggressive B-cell non-Hodgkin lymphoma, according to results of a meta-analysis published in Cancer.
“In an effort to improve the suboptimal outcomes of patients with aggressive non-Hodgkin lymphoma with intermediate-high or high age-adjusted International Prognostic Index [aaIPI], postinduction therapy intensification with high-dose therapy and autologous HSCT has been investigated,” Narendranath Epperla, MD, MS, hematologist and assistant professor in the department of internal medicine in the division of hematology at The Ohio State University College of Medicine, and colleagues wrote. “Several randomized trials in the pre-rituximab era have evaluated the role of autologous HSCT consolidation in patients with aggressive non-Hodgkin lymphoma in first remission. Meta-analyses of these pre-rituximab era randomized trials demonstrated no survival benefit for autologous HSCT in this setting.”
Epperla and colleagues sought to analyze the efficacy of autologous HSCT for this patient population in the rituximab era. They conducted a systematic review and meta-analysis of four randomized controlled trials identified in the PubMed and Cochrane databases that compared conventional chemotherapy with rituximab (Rituxan; Genentech, Biogen) with conventional chemotherapy with rituximab followed by autologous HSCT among patients with diffuse large B-cell lymphoma or other B-cell non-Hodgkin lymphomas.
The multicenter studies were conducted between 1999 and 2018 in Germany, Italy and North America and included 1,173 patients.
OS served as the primary endpoint of the systematic review. PFS, response rates, treatment-related mortality and grade 3 to grade 4 adverse events served as secondary endpoints.
Median follow-up ranged from 42 to 76 months.
Results showed no difference in OS (HR = 1.01; 95% CI, 0.74-1.37), PFS (HR = 0.77; 95% CI, 0.58-1.04), response rates (risk ratio [RR] = 0.98; 95% CI, 0.92-1.04) or treatment-related mortality (RR = 1.57; 95% CI, 0.92-2.69) between patients who received chemotherapy with rituximab plus autologous HSCT and those who received rituximab-chemotherapy alone.
An analysis limited to patients with high-risk aaIPI also showed similar OS (HR = 0.75; 95% CI, 0.47-1.19) and PFS (HR = 0.51; 95% CI, 0.23-1.1) between the treatment groups.
However, researchers observed a significantly higher risk for grade 3 or grade 4 adverse events among patients who received rituximab-chemotherapy and autologous HSCT compared with patients treated with rituximab-chemotherapy alone (RR = 4.2; 95% CI, 2.32-7.59).
“To the best of our knowledge, the current study is the first meta-analysis in the rituximab era to demonstrate no beneficial effect of upfront autologous HSCT consolidation in patients with aggressive B-cell non-Hodgkin lymphoma, including those patients in the high-risk clinical groups,” Epperla and colleagues wrote. “Larger studies urgently are needed to further define the role of upfront autologous HSCT in patients with biologically defined, poor-risk DLBCL, such as those with double-hit lymphoma.” – by John DeRosier
Disclosures: Epperla reports a speakers’ bureau role with Verastem Oncology and honoraria from Pharmacyclics for work outside the current study. Please see the study for all other authors’ relevant financial disclosures.
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