Transformed indolent lymphoma benefits from stem cell transplant at first remission
Autologous stem cell transplant at first remission for untreated transformed indolent B-cell lymphoma improved duration of disease control but showed trends toward worse overall survival, according to a presenter at ASCO2020 Virtual Scientific Program.
“Upfront autologous stem cell transplantation in first remission is associated with improved initial duration of disease control due to fewer relapses from indolent lymphoma,” Collin K. Chin, MBBS, of The University of Texas MD Anderson Cancer Center, said in the recorded presentation.
Researchers retrospectively identified patients who had biopsy-proven untreated transformed indolent B-cell lymphoma and were eligible for autologous stem cell transplant from 2000 to 2019 at three sites in Australia and the United States.
Of the 319 identified patients, 89% had follicular lymphoma. At first remission, 49 patients underwent chemotherapy and autologous stem cell transplantation. Researchers matched a cohort of 98 patients based on age, stage and status at diagnosis.
At a median 3.7 years of follow-up, Chin reported 91% progression-free survival in the stem cell transplantation group and 66% PFS in the matched cohort (HR = 0.51, 95% CI, 0.27-0.98).
“By multivariable analysis, autologous stem cell transplantation and first remission was associated with significantly improved progression-free survival with the adjustment of other important covariates in the model,” Chin said. “Other factors independently associated with inferior progression-free survival were double hit lymphoma, asymptomatic at presentation and discordant bone marrow involvement.”
After univariate analysis, Chin said autologous stem cell transplantation and first remission trended toward inferior overall survival.
“More than half of the patients who relapsed in the transplant cohort had died at last follow-up or patients died from progressive disease and the other two from secondary malignancies,” Chin said. “In comparison, only 10% of patients had died in the non-transplant cohort. ... The lack of an overall survival benefit is likely due to effective salvage therapies including CAR T-cell therapy, which may achieve long-term disease control.”
Chin suggested that careful patient selection would be an area of future research as information points to patients who are ineligible or do not have access to those effective salvage therapies.
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Chin CK, et al. Abstract 8021. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.