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Iqbal M, Kumar A, Dreger P, Chavez J, Sauter CS, Sureda AM, Bachanova V, Maziarz RT, Dreyling M, Smith SM, Jacobson C, Glass B, Casulo C, Oluwole OO, Montoto S, Advani R, Cohen J, Salles G, Hamad N, Kuruvilla J, Kahl BS, Shadman M, Kanate AS, Budde LE, Kamdar M, Flowers C, Hamadani M, Kharfan-Dabaja MA. Clinical Practice Recommendations for Hematopoietic Cell Transplantation and Cellular Therapies in Follicular Lymphoma: A Collaborative Effort on Behalf of the American Society for Transplantation and Cellular Therapy and the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:832-843. [PMID: 38972511 DOI: 10.1016/j.jtct.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma (NHL), accounting for nearly one-third of all NHL. The therapeutic landscape for patients with FL has significantly expanded over the past decade, but the disease continues to be considered incurable. Hematopoietic cell transplantation (HCT) is potentially curative in some cases. Recently, the emergence of chimeric antigen receptor T-cell therapy (CAR-T) for patients with relapsed/refractory (R/R) FL has yielded impressive response rates and long-term remissions, but definitive statement on the curative potential of CAR-T is currently not possible due to limited patient numbers and relatively short follow up. A consensus on the contemporary role, optimal timing, and sequencing of HCT (autologous or allogeneic) and cellular therapies in FL is needed. As a result, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines endorsed this effort to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 15 consensus statements/recommendations. These clinical practice recommendations will help guide clinicians managing patients with FL. Of note, the use of bispecific antibodies in R/R FL was not in the scope of this project.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida.
| | - Ambuj Kumar
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Craig S Sauter
- Division of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Anna M Sureda
- Department of Hematology, Institut Català d'Oncologia (ICO), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Martin Dreyling
- Department of Internal Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | | | - Bertram Glass
- Klinik für Hämatologie und Stammzelltransplantation, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Carla Casulo
- Department of Hematology/Oncology, University of Rochester, Rochester, New York
| | | | - Silvia Montoto
- Department of Haemato-oncology St.Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ranjana Advani
- Department of Medicine, Stanford University, Stanford, California
| | | | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Australia. School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia. School of Medicine, Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brad S Kahl
- Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | | | | | | | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, Colorado
| | - Christopher Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mehdi Hamadani
- CIBMTR/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
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2
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Merryman RW, Redd RA, Freedman AS, Ahn IE, Brown JR, Crombie JL, Davids MS, Fisher DC, Jacobsen ED, Kim AI, LaCasce AS, Ng S, Odejide OO, Parry EM, Isufi I, Kline J, Cohen JB, Mehta-Shah N, Bartlett NL, Mei M, Kuntz TM, Wolff J, Rodig SJ, Armand P, Jacobson CA. A multi-cohort phase 1b trial of rituximab in combination with immunotherapy doublets in relapsed/refractory follicular lymphoma. Ann Hematol 2024; 103:185-198. [PMID: 37851072 DOI: 10.1007/s00277-023-05475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
Antibodies targeting PD-1 or 4-1BB achieve objective responses in follicular lymphoma (FL), but only in a minority of patients. We hypothesized that targeting multiple immune receptors could overcome immune resistance and increase response rates in patients with relapsed/refractory FL. We therefore conducted a phase 1b trial testing time-limited therapy with different immunotherapy doublets targeting 4-1BB (utomilumab), OX-40 (ivuxolimab), and PD-L1 (avelumab) in combination with rituximab among patients with relapsed/refractory grade 1-3A FL. Patients were enrolled onto 2 of 3 planned cohorts (cohort 1 - rituximab/utomilumab/avelumab; cohort 2 - rituximab/ivuxolimab/utomilumab). 3+3 dose escalation was followed by dose expansion at the recommended phase 2 dose (RP2D). Twenty-four patients were enrolled (16 in cohort 1 and 9 in cohort 2, with one treated in both cohorts). No patients discontinued treatment due to adverse events and the RP2D was the highest dose level tested in both cohorts. In cohort 1, the objective and complete response rates were 44% and 19%, respectively (50% and 30%, respectively, at RP2D). In cohort 2, no responses were observed. The median progression-free survivals in cohorts 1 and 2 were 6.9 and 3.2 months, respectively. In cohort 1, higher density of PD-1+ tumor-infiltrating T-cells on baseline biopsies and lower density of 4-1BB+ and TIGIT+ T-cells in on-treatment biopsies were associated with response. Abundance of Akkermansia in stool samples was also associated with response. Our results support a possible role for 4-1BB agonist therapy in FL and suggest that features of the tumor microenvironment and stool microbiome may be associated with clinical outcomes (NCT03636503).
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Affiliation(s)
- Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA.
| | - Robert A Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Arnold S Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Inhye E Ahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Jennifer L Crombie
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Austin I Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Samuel Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Oreofe O Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Erin M Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Iris Isufi
- Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Neha Mehta-Shah
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Nancy L Bartlett
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Thomas M Kuntz
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jacquelyn Wolff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
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3
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Liu J, Hu Y, Zhao L, Nuersulitan R, Liu Y, Yu H, Ye Y, Wang D, Tang Y, Feng F, Liu W, Zhu J, Ping L, Song Y. Management and clinical outcomes of follicular lymphoma across continuous lines of treatments: a retrospective analysis in China. Front Oncol 2023; 13:1264723. [PMID: 37941553 PMCID: PMC10628462 DOI: 10.3389/fonc.2023.1264723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Background Follicular lymphoma (FL) is characterized by an incurable course that frequently necessitates multiple lines of treatment. While a range of new approaches have broadened therapeutic options for patients in later lines, data regarding treatment patterns and outcomes of Chinese patients with relapsed/refractory(R/R) FL was scarcely reported. Methods This retrospective single-center study included patients diagnosed with FL grades 1-3a at our institution between January 2002 and December 2019. Endpoints of interest were analyzed according to lines and types of interventions. The endpoints mainly included overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). Results The study enrolled 566 biopsy-proven patients. Among them, 544 patients initiated the first line of treatment, followed by 240 initiating the second line, 146 initiating the third line, 88 initiating the fourth line, 47 initiating the fifth line, and 28 initiating the sixth line. In terms of treatment patterns, anti-CD20 chemotherapy was a major modality in the first and second lines. However, for patients in the third line and subsequent lines, treatment approaches were diverse, and participation in clinical trials for new medications was common, which correlated with a survival benefit. The study also revealed that clinical indicators (such as ORR, PFS, and OS) gradually decreased with each subsequent line of treatment. The ORR at the first line was 86.6%, but decreased to 48.6% at the third line and 40.4% at the sixth line, respectively. Similarly, median OS and PFS decreased to 88.8 and 7.1 months at the third line and further reduced to 21.7 and 2.8 months at the sixth line, respectively. A total of 133 patients developed progression within 24 months from the initiation of first line anti-CD20 chemotherapy (POD24), and these patients exhibited poorer response rates and outcomes in subsequent lines of therapycompared to the non-POD24 group. Conclusion This study revealed the clinical routine practices and prognosis of R/R FL patients within the Chinese population. It underscored the unmet need for optimal strategies to improve survival and also served as a benchmark for future trials.
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Affiliation(s)
- Jiaxin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yunfei Hu
- Department of Oncology, Guizhou Medical University and Department of Lymphoma, Affiliated Hospital of Guizhou Medical University, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Linjun Zhao
- Peking University International Hospital & Institute, Department of Lymphoma, Beijing, China
| | - Reyizha Nuersulitan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hui Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yingying Ye
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dedao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yongjing Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Feier Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingyan Ping
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
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Liu X, Zheng Y, Li H, Wang M, You MJ, Tian C. Efficacy of Autologous Hematopoietic Stem Cell Transplantation versus Chemotherapy or Allogeneic Hematopoietic Stem Cell Transplantation for Follicular Lymphoma: Systematic Review and Meta-Analysis. Oncology 2023; 101:822-835. [PMID: 37598665 DOI: 10.1159/000532090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The effect of autologous hematopoietic stem cell transplantation (auto-HSCT) versus conventional chemotherapy or allogeneic hematopoietic stem cell transplantation (allo-HSCT) on the survival of patients with advanced follicular lymphoma (FL) is uncertain. OBJECTIVES To elucidate this, FL and HSCT were used as keywords to search in PubMed, Embase, Web of Science, and Cochrane Library databases. METHOD After data extraction and quality evaluation, a total of 13 studies were included, seven of which compared auto-HSCT with conventional chemotherapy and the other six compared allo-HSCT with auto-HSCT to the survival of FL patients. RESULTS The results showed that auto-HSCT improved overall survival (OS), progression-free survival, and event-free survival of FL patients compared with conventional chemotherapy without auto-HSCT. Compared with allo-HSCT, the patients receiving auto-HSCT had longer OS and lower non-recurrent mortality. CONCLUSIONS Auto-HSCT can provide a survival advantage for patients with FL compared with conventional chemotherapy and allo-HSCT did not result in a survival benefit.
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Affiliation(s)
| | - Yaxin Zheng
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | | | - Meiyi Wang
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - M James You
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chen Tian
- Department of Hematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Eyre TA, Barrington SF, Okosun J, Abamba C, Pearce RM, Lee J, Carpenter B, Crawley CR, Bloor AJC, Gilleece M, Nicholson E, Shah N, Orchard K, Malladi R, Townsend WM. Impact of positron emission tomography - computed tomography status on progression-free survival for relapsed follicular lymphoma patients undergoing autologous stem cell transplantation. Haematologica 2023; 108:785-796. [PMID: 35586966 PMCID: PMC9973492 DOI: 10.3324/haematol.2021.280287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/28/2022] [Indexed: 11/09/2022] Open
Abstract
The optimum management approach for patients with relapsed or refractory follicular lymphoma remains uncertain. Autologous stem cell transplantation (autoSCT) is considered a standard option in suitable, younger patients with relapsed follicular lymphoma. AutoSCT is associated with very durable remissions in a minority of subjects, but also with significant, well-established toxicities. Although positron emission tomography (PET) status prior to autoSCT is an established prognostic factor in diffuse large B-cell lymphoma and Hodgkin lymphoma, no data exist in follicular lymphoma. We describe survival outcomes according to pre-transplant PET status, classified by the Lugano criteria into complete metabolic remission (CMR) versus non-CMR, in 172 patients with relapsed or refractory follicular lymphoma within a national, multicenter, retrospective British Society of Blood and Marrow Transplantation and Cellular Therapy registry study. The median number of lines of therapy prior to SCT was three (range, 1-6). The median follow-up after SCT was 27 months (range, 3-70). The median progression-free survival for all patients after autoSCT was 28 months (interquartile range, 23- 36). There was no interaction between age at transplantation, sex, number of months since last relapse, Karnofsky performance status or comorbidity index and achieving CMR prior to autoSCT. Superior progression-free survival was observed in 115 (67%) patients obtaining CMR versus 57 (33%) non-CMR patients (3-year progression-free survival 50% vs. 22%, P=0.011) and by pre-SCT Deauville score (continuous variable 1-5, hazard ratio [HR]=1.32, P=0.049). PET status was independently associated with progression-free status (non-CMR HR=2.02, P=0.003), overall survival (non-CMR HR=3.08, P=0.010) and risk of relapse (non-CMR HR=1.64, P=0.046) after autoSCT by multivariable analysis. Our data suggest that pre- SCT PET status is of clear prognostic value and may help to improve the selection of patients for autoSCT.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford.
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
| | - Clementina Abamba
- BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
| | - Rachel M Pearce
- BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
| | - Julia Lee
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals 235 Euston Road, London
| | - Charles R Crawley
- Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
| | - Adrian J C Bloor
- Department of Haematology, The Christie Hospital NHS Trust, Manchester
| | - Maria Gilleece
- Department of Haematology and Bone Marrow Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Emma Nicholson
- Department of Haematology and Bone Marrow Transplantation, Royal Marsden Hospital, London
| | - Nimish Shah
- Department of Haematology, Norfolk and Norwich University Hospitals, Norwich
| | - Kim Orchard
- Department of Haematology and Bone Marrow Transplantation, Southampton University Hospitals, Southampton
| | - Ram Malladi
- Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
| | - William M Townsend
- Department of Haematology, University College London Hospitals 235 Euston Road, London
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6
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Kanters S, Ball G, Kahl B, Wiesinger A, Limbrick-Oldfield EH, Sudhindra A, Snider JT, Patel AR. Clinical outcomes in patients relapsed/refractory after ≥2 prior lines of therapy for follicular lymphoma: a systematic literature review and meta-analysis. BMC Cancer 2023; 23:74. [PMID: 36690960 PMCID: PMC9869623 DOI: 10.1186/s12885-023-10546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with follicular lymphoma (FL) can have high response rates to early lines of treatment. However, among FL patients relapsed/refractory (r/r) after ≥2 prior lines of therapy (LOT), remission tends to be shorter and there is limited treatment guidance. This study sought to evaluate the clinical outcomes for r/r FL after ≥2 prior LOT identified through systematic literature review. METHODS Eligible studies included comparative or non-comparative interventional or observational studies of systemic therapies among adults with FL r/r after ≥2 prior LOT published prior to 31st May 2021. Prior LOT must have included an anti-CD20 monoclonal antibody and an alkylating agent, in combination or separately. Overall response rate (ORR) and complete response (CR) were estimated using inverse-variance weighting with Freeman-Tukey double-arcsine transformations. Kaplan-Meier (KM) curves for progression-free survival (PFS) and overall survival (OS) estimated by reconstructing digitized curves using the Guyot algorithm, and survival analyses were conducted, stratified by ≥2 prior LOT and ≥ 3 prior LOT groups (as defined in the source material). Restricting the analyses to the observational cohorts was investigated as a sensitivity analysis. RESULTS The analysis-set included 20 studies published between 2014 and 2021. Studies were primarily US and/or European based, with the few exceptions using treatments approved in US/Europe. The estimated ORR was 58.47% (95% confidence interval [CI]: 51.13-65.62) and proportion of patients with CR was 19.63% (95% CI: 15.02-24.68). The median OS among those ≥2 prior LOT was 56.57 months (95% CI: 47.8-68.78) and median PFS was 9.78 months (95% CI: 9.01-10.63). The 24-month OS decreased from 66.50% in the ≥2 prior LOT group to 59.51% in the ≥3 prior LOT group, with a similar trend in PFS at 24-month (28.42% vs 24.13%). CONCLUSIONS This study found that few r/r FL patients with ≥2 prior LOT achieve CR, and despite some benefit, approximately 1/3 of treated patients die within 24 months. The shorter median PFS with increasing prior LOT suggest treatment durability is suboptimal in later LOT. These findings indicate that patients are underserved by treatments currently available in the US and Europe.
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Affiliation(s)
| | - Graeme Ball
- grid.437263.7Gilead Sciences Canada, Inc., Mississauga, Canada
| | - Brad Kahl
- grid.4367.60000 0001 2355 7002Oncology Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO USA
| | | | | | | | | | - Anik R. Patel
- grid.504964.aKite, A Gilead Company, Santa Monica, USA
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7
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Jacobsen E. Follicular lymphoma: 2023 update on diagnosis and management. Am J Hematol 2022; 97:1638-1651. [PMID: 36255040 DOI: 10.1002/ajh.26737] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 01/31/2023]
Abstract
DISEASE OVERVIEW Follicular lymphoma (FL) is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. FL is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal involvement is less common. Cytopenias are relatively common but constitutional symptoms of fever, night sweats, and weight loss are uncommon in the absence of transformation to diffuse large B cell lymphoma. DIAGNOSIS The diagnosis is based on histology from a biopsy of a lymph node or other affected tissue. Incisional biopsy is preferred over needle biopsies in order to give adequate tissue to assign grade and assess for transformation. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10, and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4. The presence of 0-1, 2, and ≥3 adverse factors defines low, intermediate, and high-risk disease. There are other clinical prognostic models but the FLIPI remains the most common. Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis. Regardless of the prognostic model used, modern therapies have demonstrably improved prognosis. RISK-ADAPTED THERAPY Observation continues to be appropriate for asymptomatic patients with low bulk disease and no cytopenias. There is no overall survival (OS) advantage for early treatment with either chemotherapy or single-agent rituximab. For patients needing therapy, most patients are treated with chemoimmunotherapy, which has improved overall response rates (ORR), DOR, and OS. Randomized studies have shown additional benefits for maintenance of rituximab. Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL. Kinase inhibitors, stem cell transplantation (SCT), and chimeric antigen receptor T cells (CAR-T) are also considered for recurrent disease.
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Affiliation(s)
- Eric Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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8
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Jeong SH. Treatment of indolent lymphoma. Blood Res 2022; 57:120-129. [PMID: 35483936 PMCID: PMC9057664 DOI: 10.5045/br.2022.2022054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment of indolent lymphoma has improved significantly in recent decades since the advent of rituximab (anti-CD20 monoclonal antibody). Although, some patients with limited disease can be cured with radiation therapy alone, most patients experience disease progression and recurrence during follow-up despite early initiation of treatment. Thus, watch-and-wait is still regarded the standard for asymptomatic patients. Patients with indolent lymphoma have a significant heterogeneity in terms of tumor burden, symptoms (according to anatomical sites) and the need for instant therapy. Therefore, the initiation of treatment and treatment option should be decided with a clear goal in each patient according to the need for therapy and clinical benefits with the chosen treatment. In this review, we cover the current treatment of follicular lymphoma and marginal zone lymphoma.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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Wang J, Duan X, Yang L, Liu X, Hao C, Dong H, Gu H, Tang H, Dong B, Zhang T, Gao G, Liang R. Comparison of Survival Between Autologous and Allogeneic Stem Cell Transplantation in Patients with Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma: A Meta-Analysis. Cell Transplant 2021; 29:963689720975397. [PMID: 33238731 PMCID: PMC7784574 DOI: 10.1177/0963689720975397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to compare the efficacy of allogeneic stem cell transplantation (allo-SCT) versus autologous SCT (auto-SCT) in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Medline, CENTRAL, and EMBASE databases through December 31, 2019 were searched. The primary endpoints were overall survival (OS) and progression-free survival (PFS) rates. The secondary outcomes include transplant-related mortality (TRM), event-free survival, relapse/or progression, and nonrelapse mortality (NRM). The 18 retrospective studies enrolled 8,058 B-NHL patients (allo-SCT = 1,204; auto-SCT = 6,854). The OS was significantly higher in patients receiving auto-SCT than allo-SCT (pooled odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.29 to 2.22, P < 0.001), but no significant difference was found in PFS (pooled OR: 0.98, 95% CI: 0.69 to 1.38, P = 0.891). Auto-SCT patients also had lower TRM and NRM (TRM: OR = 0.23, P < 0.001; NRM: OR = 0.16, P < 0.001), but higher relapse or progression rate (OR = 2.37, P < 0.001) than allo-SCT patients. Subgroup analysis performed for different grades and subtypes of B-NHL showed higher OS in auto-SCT patients with high-grade B-NHL and diffused large B-cell lymphoma (DLBCL). There was, nevertheless, higher PFS in allo-SCT patients with low-grade B-NHL and follicular lymphoma (FL), and lower PFS in allo-SCT patients with DLBCL than their auto-SCT counterparts. In conclusion, the meta-analysis demonstrated that relapsed or refractory B-NHL patients who received auto-SCT have improved OS than those treated with allo-SCT, especially among those with DLBCL, but lower PFS among those with FL. However, the study is limited by a lack of randomized trials, patients’ heterogeneity, and possible selection bias.
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Affiliation(s)
- Jianhong Wang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Xiaohui Duan
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Lijie Yang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Xiangxiang Liu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Caixia Hao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hongjuan Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hongtao Gu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Hailong Tang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Baoxia Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Tao Zhang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Guangxun Gao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China
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Cost-effectiveness analysis of allogeneic versus autologous stem cell transplant versus chemo-immunotherapy for early relapse of follicular lymphoma within 2 years of initial therapy. Bone Marrow Transplant 2021; 56:2400-2409. [PMID: 33986499 DOI: 10.1038/s41409-021-01327-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022]
Abstract
This study compared the quality-adjusted effectiveness and costs of three treatment options for transplant-eligible patients with early progression (POD24) of follicular lymphoma. A Markov decision-analytic model using a 20-year time horizon was used to compare allogeneic stem cell transplant (alloSCT), autologous stem cell transplant (ASCT), and chemo-immunotherapy (O-CHOP). For second relapse/refractory disease, novel therapy use was modeled, including lenalidomide and rituximab/obinutuzumab, and PI3K inhibitors (PI3Ki). Costs were considered from a Canadian public health payer's perspective. Probabilistic analyses (10,000 simulations) demonstrated that at a willingness-to-pay threshold of $50,000, ASCT was most cost effective 60% of the time. ASCT resulted in more life years (10.2 vs. alloSCT 9.9 vs. O-CHOP 10.0) and quality-adjusted life years (7.5 vs. alloSCT 6.6 vs. O-CHOP 7.4), with the lowest direct costs ($190,128 CAD). In sensitivity analyses, the model was robust to key variables, including differing probabilities of progression, non-relapse mortality, graft-versus-host-disease (GVHD), costs of treating GVHD, costs of PI3Ki, and probability of secondary malignancy from ASCT. However, if patients were older than 65 years or their life expectancy was less than 10 years, chemo-immunotherapy was the preferred strategy. When considering cost, effectiveness, and toxicities, the preferred treatment strategy for most patients with POD24 follicular lymphoma is ASCT.
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11
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Shah NN, Hamadani M. Is There Still a Role for Allogeneic Transplantation in the Management of Lymphoma? J Clin Oncol 2021; 39:487-498. [PMID: 33434076 DOI: 10.1200/jco.20.01447] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nirav N Shah
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mehdi Hamadani
- Blood and Bone Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI.,Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Okosun J, Montoto S. Cellular Therapy in Follicular Lymphoma: Autologous Stem Cell Transplantation, Allogeneic Stem Cell Transplantation, and Chimeric Antigen Receptor T-cell Therapy. Hematol Oncol Clin North Am 2020; 34:701-714. [PMID: 32586575 DOI: 10.1016/j.hoc.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A subset of follicular lymphoma patients with high-risk clinical features continues to pose a therapeutic challenge. Hematopoietic stem cell transplantation is a suitable consolidative treatment option for these patients. Data on chimeric antigen receptor T-cell therapy are promising in relapsed/refractory and transformed patients. The increasing armamentarium of nontransplant options coupled with the associated potential long-term sequelae of transplantation raises questions about the placement of transplant strategies in the follicular lymphoma treatment hierarchy.
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Affiliation(s)
- Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK.
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Carella M, Stefoni V, Pellegrini C, Argnani L, Cavo M, Zinzani PL. Finalization of autologous stem cell transplant in complex and multirelapsed follicular lymphoma. TUMORI JOURNAL 2020; 106:NP5-NP8. [PMID: 32442038 DOI: 10.1177/0300891620923039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Follicular lymphoma (FL) is characterized by frequent relapses and need for multitude lines of therapy, which includes different immunochemotherapy regimens, novel monoclonal antibodies, novel drugs, and autologous or allogenic stem cell transplant. Early use of autologous stem cell transplantation (ASCT) improves prognosis in patients with FL who may be candidates for an aggressive approach. CASE PRESENTATION We report the case of a 49-year-old woman with thrombophilia with relapsed/refractory grade 3A FL, heavily pretreated, who achieved third complete remission after high-dose chemotherapy and ASCT, despite experiencing life-threatening adverse events during her treatment history. CONCLUSIONS Stem cell transplantation has emerged as the standard of care for young patients with FL but may be effective also in complex and multirelapsed clinical cases.
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Affiliation(s)
- Matteo Carella
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Vittorio Stefoni
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Lisa Argnani
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Michele Cavo
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
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14
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Freedman A, Jacobsen E. Follicular lymphoma: 2020 update on diagnosis and management. Am J Hematol 2020; 95:316-327. [PMID: 31814159 DOI: 10.1002/ajh.25696] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Follicular lymphoma (FL) is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. Follicular lymphoma is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal involvement is less common. Cytopenias are relatively common but constitutional symptoms of fever, night sweats, and weight loss are uncommon in the absence of transformation to diffuse large B cell lymphoma. DIAGNOSIS The diagnosis is based on histology from a biopsy of a lymph node or other affected tissue. Incisional biopsy is preferred over needle biopsies in order to give adequate tissue to assign grade and assess for transformation. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10 and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age > 60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4. The presence of 0-1, 2, and ≥ 3 adverse factors defines low, intermediate, and high-risk disease. There are other clinical prognostic models but the FLIPI remains the most common. Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis. Regardless of the prognostic model used, modern therapies have demonstrably improved prognosis. RISK-ADAPTED THERAPY Observation continues to be appropriate for asymptomatic patients with low bulk disease and no cytopenias. There is no overall survival advantage for early treatment with either chemotherapy or single agent rituximab. For patients needing therapy, most patients are treated with chemoimmunotherapy, which has improved response rates, duration of response and overall survival (OS). Randomized studies have shown additional benefit for maintenance rituximab. Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL. Kinase inhibitors, other immunotherapies, and stem cell transplantation (SCT) are also considered for recurrent disease.
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Affiliation(s)
- Arnold Freedman
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Eric Jacobsen
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
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15
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Sesques P, Bourcier J, Golfier C, Lebras L, Nicolas-Virelizier E, Hacini M, Perrin MC, Voillat L, Bachy E, Traverse-Glehen A, Moreau A, Martin L, Ramla S, Casasnovas O, Le Gouill S, Salles G, Ghesquières H. Clinical characteristics and outcomes of relapsed follicular lymphoma after autologous stem cell transplantation in the rituximab era. Hematol Oncol 2020; 38:137-145. [PMID: 31953963 DOI: 10.1002/hon.2713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a therapeutic option for patients with relapsed follicular lymphoma (FL). The clinical characteristics and outcomes of FL relapse after ASCT in the rituximab era have not yet been fully elucidated. We retrospectively reviewed 414 FL patients treated with ASCT between 2000 and 2014 in four hematology departments. All patients received rituximab as a first-line treatment. We specifically analyzed the clinical characteristics, treatment strategies at relapse, and outcomes of 95 patients (23%) who relapsed after ASCT. The patients (median age, 57 y) received a median of two lines of therapy (range, 2-6) prior to ASCT, with 92% in complete response (CR) or partial response (PR) before ASCT. Histological transformation at relapse after ASCT was observed in 20% of the patients. Treatment at relapse after ASCT consisted of chemotherapy with or without rituximab (n = 45/90, 50%), targeted agents (18%), rituximab monotherapy (14%), or consolidation allogeneic transplantation after induction chemotherapy (12%) and radiotherapy (6%). After relapse, the median progression-free survival (PFS) and overall survival (OS) were 1 year (95% CI, 0.541-1.579) and 5.5 years (95% CI, 1.910-9.099), respectively. In the multivariate analysis, histological transformation (HT) was associated with OS (P = .044; HR 2.439; 95% CI, 1.025-5.806), and a high FLIPI score at relapse was associated with PFS (P = .028; HR 2.469; 95% CI, 1.104-5.521). This retrospective study showed that the period of PFS of patients who relapsed after ASCT is short. A biopsy should be performed for these patients to document the HT. Our results indicate that new treatment strategies will need to be developed for these patients.
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Affiliation(s)
- Pierre Sesques
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Jessie Bourcier
- Department of Hematology, Nantes University Hospital, CHU of Nantes and CHD Vendée, La Roche-sur-Yon, France
| | - Camille Golfier
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Laure Lebras
- Department of Hematology, Centre Léon Bérard, Lyon, France
| | | | - Maya Hacini
- Department of Hematology, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Marie Claire Perrin
- Department of Hematology, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Laurent Voillat
- Department of Hematology, Centre Hospitalier of Chalon-sur-Saône, Chalon-sur-Saône, France
| | - Emmanuel Bachy
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- Department of Pathology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Anne Moreau
- Department of Pathology, CHU of Nantes, Nantes, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Selim Ramla
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Steven Le Gouill
- Department of Hematology, CHU of Nantes CRCINA INSERM team 10 Nantes, Nantes University NUN Next, Nantes, France
| | - Gilles Salles
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Hervé Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
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16
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Chow VA, Gopal AK. Where does transplant fit in the age of targeted therapies? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:287-293. [PMID: 31808860 PMCID: PMC6913492 DOI: 10.1182/hematology.2019000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The role of hematopoietic cell transplantation (HCT) for indolent lymphoma has evolved over the last 5 years with the availability of novel low-toxicity therapies and a better understanding of the prognosis of these entities. However, despite numerous treatment options for patients with follicular lymphoma, none are thought to be curative, and many require ongoing therapy with chronic toxicity. Historical trials indicate that autologous HCT as initial consolidation leads to improved progression-free survival, but not overall survival (OS) and, thus, is not typically recommended. However, autologous HCT for chemosensitive relapse can be carried out with ∼1% early mortality risk, affording disease control lasting a median of 3 to 5 years and the potential to improve OS. These results may compare favorably in efficacy, toxicity, and cost vs multiple sequential novel therapies with shorter durations of benefit. Recent data indicate that autologous HCT in follicular lymphoma patients with early initial progression will result in more than one third being alive and without relapse at 5 years, leading to improved OS when used within a year of the first recurrence. Unlike other available therapies, allogeneic HCT has the potential to cure up to one half of those transplanted with indolent B-cell non-Hodgkin lymphoma, although the risks need to be recognized and appropriate patient and donor selection is critical to ensure the best outcomes. HCT continues to remain a viable option in the current era of multiple targeted agents.
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Affiliation(s)
- Victor A Chow
- Division of Medical Oncology, University of Washington, Seattle, WA; and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ajay K Gopal
- Division of Medical Oncology, University of Washington, Seattle, WA; and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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17
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Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Rodriguez A, Lorza L, Martín A, Coria E, López-Guillermo A, Salar A, José Lahuerta J. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure without the need for immunotherapy. Hematol Oncol Stem Cell Ther 2019; 12:194-203. [DOI: 10.1016/j.hemonc.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/23/2019] [Indexed: 12/01/2022] Open
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18
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Dada R, Al-Mansour M, Alhashmi H, Kandil M, Alhejazi A, Sagheir A, Alzahrani M, Motabi I. Follicular Lymphoma: Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:214-218. [PMID: 31543747 PMCID: PMC6734728 DOI: 10.4103/sjmms.sjmms_101_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/06/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Magdy Kandil
- Oncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Clinical Oncology Department, Cairo University, Giza, Egypt
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Central Region, Riyadh, Saudi Arabia
| | - Ahmed Sagheir
- Oncology Institute, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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19
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Abstract
PURPOSE OF REVIEW A multitude of new drug and cell therapy approvals for lymphoma has prompted questions about the role of allogeneic blood or marrow transplantation (allo-BMT). We sought to review the latest evidence examining the role of allo-BMT for lymphoma in this evolving landscape. RECENT FINDINGS Despite several new drug classes, there remains a large unmet need, particularly in hard to treat subtypes of lymphoma and for patients with relapsed/refractory disease. Allo-BMT can provide an opportunity for cure due to a potent graft vs lymphoma effect in high-risk relapse/refractory follicular lymphoma, mantle cell lymphoma, and aggressive T cell lymphomas. Chimeric antigen receptor T cell therapy and checkpoint blockers have improved outcomes for patients with relapsed /aggressive B cell lymphomas and Hodgkin lymphoma respectively; the role of allo-BMT consolidation in the treatment algorithm for responders to these therapies is an evolving topic. Expanded donor availability including haploidentical relatives has improved access to allo-BMT. Non-myeloablative conditioning regimens and post-transplant cyclophosphamide prophylaxis have improved early transplant-related morbidity and rates of graft versus host disease and translated into long-term survival for patients with lymphoid malignancies. Patient selection remains key, but allo-BMT remains the only modality able to deliver durable long-term remissions across different types of lymphoma.
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20
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Hunter BD, Chen YB, Jacobson CA. Allogeneic Stem Cell Transplantation and Chimeric Antigen Receptor (CAR) T-Cell Therapy for the Treatment of Non-Hodgkin Lymphoma. Hematol Oncol Clin North Am 2019; 33:687-705. [PMID: 31229163 DOI: 10.1016/j.hoc.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite the myriad of available treatments, a substantial subset of patients with non-Hodgkin lymphoma are not able to achieve a prolonged disease-free interval with conventional chemotherapy or targeted agents. For these patients, hematopoietic stem cell transplantation remains an option for consolidative or curative treatment. Additionally, chimeric antigen receptor T-cell therapy has emerged for patients with relapsed/refractory B-cell lymphomas. Published studies vary widely in their selected approach to transplant and cellular therapies. This review summarizes available data related to allogeneic hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy for the treatment of non-Hodgkin lymphomas.
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Affiliation(s)
- Bradley D Hunter
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA.
| | - Yi-Bin Chen
- Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA
| | - Caron A Jacobson
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
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21
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Norman JE, Schouten HC, Dreger P, Robinson SP. The role of stem cell transplantation in the management of relapsed follicular lymphoma in the era of targeted therapies. Bone Marrow Transplant 2018; 54:787-797. [DOI: 10.1038/s41409-018-0372-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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22
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Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Martínez-Sánchez P, Martín A, Coria E, López-Guillermo A, Salar A, Lahuerta JJ. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment. Hematol Oncol 2018; 36:765-772. [PMID: 30129233 DOI: 10.1002/hon.2553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/04/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Reyes Arranz
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Santiago Mercadal
- Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Spain
| | - Andrea Galeo
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | - Elena Pérez
- Hospital Universitario Morales de Messeguer, Murcia, Spain
| | - Carmen Marrero
- Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
| | | | - Luis Palomera
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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23
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Tsukamoto N, Yokohama A, Higuchi T, Mitsui T, Koiso H, Takizawa M, Shimizu H, Ishizaki T, Matsumoto M, Toyama K, Sakura T, Ogura H, Saitoh T, Ishida F, Murakami H, Tsushima Y, Handa H. Tumor long-axis diameter and SUVmax predict long-term responders in 90Y-ibritumomab tiuxetan monotherapy. Int J Hematol 2018; 109:91-97. [PMID: 30203253 DOI: 10.1007/s12185-018-2526-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
90Y-ibritumomab tiuxetan (90Y-IT) is widely used, but the factors responsible for its optimal treatment effects are unknown. We enrolled 34 patients with relapsed indolent lymphoma treated with 90Y-IT monotherapy at Gunma University Hospital between 2003 and 2014 in the present study. Clinical data including computed tomography and 18-Fluoro-deoxyglucose positron emission tomography were retrospectively analyzed. The overall response rate and complete response rate were 91% and 82%, respectively. The median progression-free survival (PFS) and overall survival were 32 months and not reached, respectively. In univariate analysis, tumor long-axis diameter ≤ 2.5 cm, maximum standardized uptake value (SUVmax) ≤ 6.5, localized disease, normal levels of serum soluble interleukin-2 receptor, and the number of involved nodal sites ≤ 3 immediately prior to 90Y-IT were associated with median PFS greater than 6 years. However, in multivariate analysis, only tumor long-axis diameter ≤ 2.5 cm and SUVmax ≤ 6.5 affected PFS [hazard ratio (HR) 0.130, P = 0.0021 and HR 0.283, P = 0.0311, respectively]. Patients with only one prior regimen needed less granulocyte colony-stimulating factor and platelet transfusion. Thus, 90Y-IT treatment should be considered for patients with indolent lymphoma in first relapse who have tumor long-axis diameter ≤ 2.5 cm and SUVmax ≤ 6.5.
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Affiliation(s)
- Norifumi Tsukamoto
- Oncology Center, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Akihiko Yokohama
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Transfusion Service, Gunma University Hospital, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, University Graduate School of Medicine, Maebashi, Japan
| | - Takeki Mitsui
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiromi Koiso
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Makiko Takizawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroaki Shimizu
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuma Ishizaki
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Morio Matsumoto
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Kohtaro Toyama
- Division of Internal Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Tohru Sakura
- Division of Internal Medicine, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Hidemi Ogura
- Division of Internal Medicine, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takayuki Saitoh
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Fumihiro Ishida
- Department of Biomedical Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hirokazu Murakami
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Manna M, Lee-Ying R, Davies G, Stewart C, Oh DH, Peters A, Stewart DA. Autologous transplantation improves survival rates for follicular lymphoma patients who relapse within two years of chemoimmunotherapy: a multi-center retrospective analysis of consecutively treated patients in the real world. Leuk Lymphoma 2018; 60:133-141. [DOI: 10.1080/10428194.2018.1473576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mita Manna
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Richard Lee-Ying
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Gwynivere Davies
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Colin Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Danielle H. Oh
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Anthea Peters
- Department of Medicine, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Douglas A. Stewart
- Department of Oncology and Medicine, University of Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada
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25
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Efficacy of Idelalisib as Bridge to Allogeneic Stem Cell Transplant in Relapsed Follicular Lymphoma: A Case Report. TUMORI JOURNAL 2018; 103:e41-e43. [DOI: 10.5301/tj.5000679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 01/13/2023]
Abstract
Purpose A large number of new therapeutic agents have been studied for patients with relapsed/refractory follicular lymphoma (FL). Among new therapies, idelalisib, a novel PI3K inhibitor, shows promising results in the management of this disease. Case report We describe the case of a 39-year-old patient with a diagnosis of grade 3a FL and a Follicular Lymphoma International Prognostic Index score of 2, who underwent several lines of therapy (including autologous stem cell transplant) with transient responses or no response at all. The patient was subsequently treated with 5 courses of idelalisib monotherapy, achieving a partial response. No relevant toxicities occurred. The patient underwent allogeneic stem cell transplant (allo-SCT) from an unrelated donor and obtained a complete response, which was confirmed after 3, 6, 9, and 12 months, and is still ongoing. Conclusions As previously reported, the achievement of a good response is predictive for a better outcome after allo-SCT: idelalisib represents an effective treatment option for patients with relapsed/refractory FL, which can also be adopted as a bridge to allo-SCT.
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26
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Smith SM, Godfrey J, Ahn KW, DiGilio A, Ahmed S, Agrawal V, Bachanova V, Bacher U, Bashey A, Bolaños-Meade J, Cairo M, Chen A, Chhabra S, Copelan E, Dahi PB, Aljurf M, Farooq U, Ganguly S, Hertzberg M, Holmberg L, Inwards D, Kanate AS, Karmali R, Kenkre VP, Kharfan-Dabaja MA, Klein A, Lazarus HM, Mei M, Mussetti A, Nishihori T, Geethakumari PR, Saad A, Savani BN, Schouten HC, Shah N, Urbano-Ispizua A, Vij R, Vose J, Sureda A, Hamadani M. Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure. Cancer 2018; 124:2541-2551. [PMID: 29645093 PMCID: PMC5990449 DOI: 10.1002/cncr.31374] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early treatment failure (ETF) in follicular lymphoma (FL), defined as relapse or progression within 2 years of frontline chemoimmunotherapy, is a newly recognized marker of poor survival and identifies a high-risk group of patients with an expected 5-year overall survival (OS) rate of approximately 50%. Transplantation is an established option for relapsed FL, but its efficacy in this specific ETF FL population has not been previously evaluated. METHODS This study compared autologous hematopoietic stem cell transplantation (auto-HCT) with either matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic hematopoietic cell transplantation (allo-HCT) as the first transplantation approach for patients with ETF FL (age ≥ 18 years) undergoing auto-HCT or allo-HCT between 2002 and 2014. The primary endpoint was OS. The secondary endpoints were progression-free survival, relapse, and nonrelapse mortality (NRM). RESULTS Four hundred forty FL patients had ETF (auto-HCT, 240; MSD hematopoietic stem cell transplantation [HCT], 105; and MUD HCT, 95). With a median follow-up of 69 to 73 months, the adjusted probability of 5-year OS was significantly higher after auto-HCT (70%) or MSD HCT (73%) versus MUD HCT (49%; P = .0008). The 5-year adjusted probability of NRM was significantly lower for auto-HCT (5%) versus MSD (17%) or MUD HCT (33%; P < .0001). The 5-year adjusted probability of disease relapse was lower with MSD (31%) or MUD HCT (23%) versus auto-HCT (58%; P < .0001). CONCLUSIONS Patients with high-risk FL, as defined by ETF, undergoing auto-HCT for FL have low NRM and a promising 5-year OS rate (70%). MSD HCT has lower relapse rates than auto-HCT but similar OS. Cancer 2018;124:2541-51. © 2018 American Cancer Society.
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MESH Headings
- Adult
- Aged
- Disease Progression
- Disease-Free Survival
- Female
- Follow-Up Studies
- Graft vs Host Disease/epidemiology
- Graft vs Host Disease/immunology
- Graft vs Host Disease/prevention & control
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Incidence
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Survival Rate
- Transplantation Conditioning/methods
- Transplantation, Autologous/adverse effects
- Transplantation, Autologous/methods
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/methods
- Treatment Failure
- Young Adult
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Affiliation(s)
- Sonali M. Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | | | - Kwang Woo Ahn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa DiGilio
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Vaibhav Agrawal
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Veronika Bachanova
- Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Andy Chen
- Oregon Health and Science University, Portland, OR, USA
| | | | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Parastoo B. Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick NSW, Australia
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Abraham S. Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | | | | | - Mohamed A. Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andreas Klein
- Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Hillard M. Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Alberto Mussetti
- Department of Hematology and Pediatric Onco-Hematology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harry C. Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Nairav Shah
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alvaro Urbano-Ispizua
- Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS, and Institute of Research Josep Carreras, Barcelona, Spain
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Anna Sureda
- Hematology Department, Institut Català d’Oncologia - Hospitalet, Barcelona, Spain
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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27
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Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O. Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: A Follow-Up Study of 2 Randomized Trials from the German Low Grade Lymphoma Study Group. Biol Blood Marrow Transplant 2018; 24:1172-1179. [DOI: 10.1016/j.bbmt.2018.03.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
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28
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Casulo C, Friedberg JW, Ahn KW, Flowers C, DiGilio A, Smith SM, Ahmed S, Inwards D, Aljurf M, Chen AI, Choe H, Cohen J, Copelan E, Farooq U, Fenske TS, Freytes C, Gaballa S, Ganguly S, Jethava Y, Kamble RT, Kenkre VP, Lazarus H, Lazaryan A, Olsson RF, Rezvani AR, Rizzieri D, Seo S, Shah GL, Shah N, Solh M, Sureda A, William B, Cumpston A, Zelenetz AD, Link BK, Hamadani M. Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2018; 24:1163-1171. [PMID: 29242111 PMCID: PMC5993598 DOI: 10.1016/j.bbmt.2017.12.771] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
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 non-autoHCT 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.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | | | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Alyssa DiGilio
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia
| | - Andy I Chen
- Blood and Marrow Transplant Program, Oregon Health and Science University, Portland, Oregon
| | - Hannah Choe
- Blood and Marrow Transplant Program, Weill Cornell Medical College, New York, New York
| | - Jonathon Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Umar Farooq
- Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cesar Freytes
- Blood and Marrow Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Sameh Gaballa
- Blood and Marrow Transplant Program, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Yogesh Jethava
- Blood and Marrow Transplant Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Aleksandr Lazaryan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Andrew R Rezvani
- Blood and Marrow Transplant Program, Stanford Health Care, Stanford, California
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Chiba, Japan
| | - Gunjan L Shah
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nina Shah
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of MD Anderson Cancer Center, Houston, Texas
| | - Melham Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Basem William
- James Cancer Center, Ohio State Medical Center, Columbus, Ohio
| | - Aaron Cumpston
- Blood and Marrow Transplant Program, West Virginia University Hospitals, Morgantown, West Virginia
| | - Andrew D Zelenetz
- Blood and Marrow Transplant Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian K Link
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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29
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Freedman A. Follicular lymphoma: 2018 update on diagnosis and management. Am J Hematol 2018; 93:296-305. [PMID: 29314206 DOI: 10.1002/ajh.24937] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 12/22/2022]
Abstract
DISEASE OVERVIEW Follicular lymphoma is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. Follicular lymphoma (FL) is characterized by diffuse lymphadenopathy, bone marrow involvement, splenomegaly and less commonly other extranodal sites of involvement. In general, cytopenias can occur but constitutional symptoms of fever, nightsweats, and weight loss are uncommon. DIAGNOSIS Diagnosis is based on histology of preferably a biopsy of a lymph node. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10, and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index prognostic model for FL uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas > 4. The presence of 0, 1, 2, and ≥ 3 adverse factors defines low, intermediate, and high-risk disease. With the use of more modern therapies, outcomes have improved. RISK-ADAPTED THERAPY Observation continues to be adequate for asymptomatic patients with low bulk disease and no cytopenias, with no survival advantage for early treatment with either chemotherapy or rituximab alone. For patients needing therapy, most patients are treated with chemotherapy plus rituximab, which has improved response rates, duration of response and overall survival. Randomized studies have shown additional benefit for maintenance rituximab both following chemotherapy-rituximab and single agent rituximab. Experimental therapies as well as stem cell transplantation (SCT) are considered for recurrent disease.
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Affiliation(s)
- Arnold Freedman
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
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30
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Gauthier J, Chantepie S, Bouabdallah K, Jost E, Nguyen S, Gac AC, Damaj G, Duléry R, Michallet M, Delage J, Lewalle P, Morschhauser F, Salles G, Yakoub-Agha I, Cornillon J. [Allogeneic haematopoietic cell transplantation for indolent lymphomas: Guidelines from the Francophone Society Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S121-S130. [PMID: 29173973 DOI: 10.1016/j.bulcan.2017.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 10/18/2022]
Abstract
Despite great improvements in the outcome of patients with lymphoma, some may still relapse or present with primary refractory disease. In these situations, allogeneic hematopoietic cell transplantation is a potentially curative option, this is true particularly the case of relapse after autologous stem cell transplantation. Recently, novel agents such as anti-PD1 and BTK inhibitors have started to challenge the use of allogeneic hematopoietic cell transplantation for relapsed or refractory lymphoma. During the 2016 annual workshop of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), we performed a comprehensive review of the literature published in the last 10 years and established guidelines to clarify the indications and transplant modalities in this setting. This paper specifically reports on our conclusions regarding indolent lymphomas, mainly follicular lymphoma and chronic lymphocytic leukemia.
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Affiliation(s)
- Jordan Gauthier
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; Université de Lille, UFR médecine, 59000 Lille, France
| | - Sylvain Chantepie
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | | | - Edgar Jost
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | | | - Anne-Claire Gac
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | - Gandhi Damaj
- AP-HP, hôpital La Pitié-Salpêtrière, service d'hématologie, 75013 Paris, France
| | - Rémy Duléry
- AP-HP, hôpital Saint-Antoine, service d'hématologie, 75012 Paris, France
| | | | - Jérémy Delage
- CHU de Montpellier, service d'hématologie, 34295 Montpellier, France
| | - Philippe Lewalle
- Université libre de Bruxelles, institut Jules-Bordet, service d'hématologie, Bruxelles, Belgique
| | - Franck Morschhauser
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; Université de Lille, UFR médecine, 59000 Lille, France
| | - Gilles Salles
- CHU de Lyon, service d'hématologie, 69310 Pierre-Bénite, France
| | - Ibrahim Yakoub-Agha
- CHRU de Lille, pôle spécialités médicales et gérontologie, service des maladies du sang, secteur allogreffe de cellules souches hématopoïétiques, 59037 Lille, France; CHU de Lille, université de Lille2, LIRIC Inserm U995, 59000 Lille, France
| | - Jérôme Cornillon
- Institut de cancérologie Lucien-Neuwirth, département d'hématologie clinique, 42271 Saint-Priest-en-Jarez, France.
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31
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Hess G. The role of stem cell transplantation in follicular lymphoma. Best Pract Res Clin Haematol 2017; 31:31-40. [PMID: 29452664 DOI: 10.1016/j.beha.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
Abstract
With the introduction of novel treatments paradigms to if or when to use transplantation strategies for patients with follicular lymphoma have changed substantially. Autologous transplantation has been intensively evaluated as consolidation after first induction treatment with positive effects, however the introduction of Rituximab led to comparable improvements and HDT has been moved to relapse treatment. In this indication HDT was frequently use already at first relapse, but now is dominantly used in patients with a highrisk profile, e.g. failure of response, early or multiply relapse and/or signs of transformation. The ideal place for allogeneic transplantation is even harder to define, as the curative potential might be outweighed by the substantial side effect profile and the indication must always be discussed in the light of available alternatives. In consequence, transplantation strategies remain an important therapeutic instrument for patients with FL, however timing within the treatment course has to be defined individually.
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Affiliation(s)
- Georg Hess
- Department of Hematology, Oncology and Pneumology, University Cancer Center Mainz, University Medical School of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany.
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Epperla N, Hamadani M. Hematopoietic cell transplantation for diffuse large B-cell and follicular lymphoma: Current controversies and advances. Hematol Oncol Stem Cell Ther 2017. [PMID: 28633038 DOI: 10.1016/j.hemonc.2017.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with diverse biologic, histologic, and clinical features. With a better understanding of the molecular pathogenesis, recently there have been major advances in the treatment of NHLs including addition of novel monoclonal antibodies, targeted therapies, and immune activators to the therapy armamentarium. Despite these remarkable developments, autologous hematopoietic cell transplantation (auto-HCT) remains not only a standard-of-care curative option for aggressive NHL but also an important therapeutic option for indolent NHL. In NHL, for patients with high-risk features, including those heavily pretreated or with refractory disease or those experiencing failure after an auto-HCT, allogeneic HCT (allo-HCT) remains the only curative option. In this review, we briefly discuss the role of transplantation in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). In DLBCL patients, we discuss the role of HCT in clinically and biologically defined ultra-high-risk disease. In FL patients, auto-HCT is best reserved for relapsed chemosensitive patients after two to three lines of prior chemoimmunotherapies, who are not candidates for allo-HCT, either because of donor unavailability, associated comorbidities, or patient preference. Reduced-intensity conditioning allo-HCT offers the curative option for patients with relapsed/refractory FL. Although the emergence of targeted, biologic, and immunological therapies is welcoming, it is currently unclear how these new therapies might enhance or replace allo-HCT. Until we have further definitive data, allo-HCT remains the only curative option.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for International Blood and Marrow Transplant Research, Milwaukee, WI 53226, USA.
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Krishnan AY, Palmer J, Nademanee AP, Chen R, Popplewell LL, Tsai NC, Sanchez JF, Simpson J, Spielberger R, Yamauchi D, Forman SJ. Phase II Study of Yttrium-90 Ibritumomab Tiuxetan Plus High-Dose BCNU, Etoposide, Cytarabine, and Melphalan for Non-Hodgkin Lymphoma: The Role of Histology. Biol Blood Marrow Transplant 2017; 23:922-929. [PMID: 28267593 PMCID: PMC5646666 DOI: 10.1016/j.bbmt.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/01/2017] [Indexed: 11/23/2022]
Abstract
Standard-dose 90yttrium-ibritumomab tiuxetan (.4 mci/kg) together with high-dose BEAM (BCNU, etoposide, cytarabine, and melphalan) (Z-BEAM) has been shown to be a well-tolerated autologous hematopoietic stem cell transplantation preparative regimen for non-Hodgkin lymphoma. We report the outcomes of a single-center, single-arm phase II trial of Z-BEAM conditioning in high-risk CD20+ non-Hodgkin lymphoma histologic strata: diffuse large B cell (DLBCL), mantle cell, follicular, and transformed. Robust overall survival and notably low nonrelapse mortality rates (.9% at day +100 for the entire cohort), with few short- and long-term toxicities, confirm the safety and tolerability of the regimen. In addition, despite a high proportion of induction failure patients (46%), the promising response and progression-free survival (PFS) rates seen in DLBCL (3-year PFS: 71%; 95% confidence interval, 55 to 82%), support the premise that the Z-BEAM regimen is particularly effective in this histologic subtype. The role of Z-BEAM in other strata is less clear in the context of the emergence of novel agents.
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Affiliation(s)
- Amrita Y Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Joycelynne Palmer
- Department of Information Sciences, City of Hope, Duarte, California
| | - Auayporn P Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Leslie L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ni-Chun Tsai
- Department of Information Sciences, City of Hope, Duarte, California
| | - James F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - Ricardo Spielberger
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Southern California Kaiser Permanente Bone Marrow Transplant Program, Los Angeles, California
| | - Dave Yamauchi
- Department of Diagnostic Radiology, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
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The Role of Autologous and Allogeneic Stem Cell Transplantation in Follicular Lymphoma in The New Drugs Era. Mediterr J Hematol Infect Dis 2016; 8:e2016045. [PMID: 27648208 PMCID: PMC5016019 DOI: 10.4084/mjhid.2016.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023] Open
Abstract
Follicular lymphoma (FL) is the second most common histotype of non-Hodgkin’s lymphoma, and it is generally characterized by a heterogeneous clinical course. Despite recent therapeutic and diagnostic improvements, a significant fraction of FL patients still relapsed. In younger and/or fit FL relapsed patients bone marrow transplant (BMT) has represented the main salvage therapy for many years. Thanks to the ability of high-dose chemotherapy to overcome the lymphoma resistance and refractoriness, autologous stem cell transplantation (ASCT) can achieve a high complete remission rate (CR) and favorable outcome regarding progression-free survival (PFS) and overall survival (OS). Allogeneic stem cell transplantation (alloSCT) combines the high dose chemotherapy effect together with the immune reaction of the donor immune system against lymphoma, the so-called ‘graft versus lymphoma’ (GVL) effect. Considering the generally higher transplant-related mortality (TRM), alloSCT is mostly indicated for FL relapsed after ASCT. During the last years, there have been a great spread of novel effective and feasible drugs Although these and future novel drugs will probably change our current approach to FL, the OS post-BMT (ASCT and alloSCT) has never been reproduced by any novel combination. In this scenario, it is important to correctly evaluate the disease status, the relapse risk and the comorbidity profile of the relapsed FL patients in order to provide the best salvage therapy and eventually transplant consolidation.
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Capria S, Barberi W, Perrone S, Ferretti A, Salaroli A, Annechini G, D'Elia GM, Foà R, Pulsoni A. Reappraising the timing of transplant for indolent non-Hodgkin lymphomas. Expert Rev Hematol 2016; 9:951-64. [PMID: 27539362 DOI: 10.1080/17474086.2016.1226128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Indolent non-Hodgkin lymphomas (iNHL) remain incurable with standard approaches. The timing of autologous stem cell transplant (ASCT) is changing following the introduction of new drugs that can potentially defer the transplant, improved reduced intensity conditioning (RIC) and haploidentical allogeneic SCT (allo-SCT). AREAS COVERED The most relevant aspects concerning the role of hematopoietic stem cell transplantation in the management of iNHL are discussed. Literature search methodology included examination of PubMed index and meeting presentations. Expert commentary: ASCT is not currently employed as consolidation in first-line, being reserved to patients with refractory/relapsed disease. The curative potential of graft-versus-lymphoma (GVL) after RIC allo-SCT could be particularly beneficial in patients with iNHL relapsing after ASCT. This scenario could be modified in the near future by better definition of high-risk patients at diagnosis, by the improvement of minimal residual disease (MRD) evaluation and by the introduction of new drugs in the therapeutic algorithm.
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Affiliation(s)
- Saveria Capria
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Walter Barberi
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Salvatore Perrone
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Antonietta Ferretti
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Adriano Salaroli
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Giorgia Annechini
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Gianna Maria D'Elia
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Robin Foà
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Alessandro Pulsoni
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
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Oh DH, Li H, Duan Q, Villa D, Peters A, Chua N, Owen CJ, Connors JM, Stewart DA. Quantifying Benefit of Autologous Transplantation for Relapsed Follicular Lymphoma Patients via Instrumental Variable Analysis. Biol Blood Marrow Transplant 2016; 22:941-8. [DOI: 10.1016/j.bbmt.2016.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma. Blood 2016; 127:2093-100. [DOI: 10.1182/blood-2015-11-624320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/24/2016] [Indexed: 11/20/2022] Open
Abstract
Abstract
Despite improvements over the past decade in the overall survival of patients with indolent non-Hodgkin lymphomas, these lymphomas remain largely incurable with standard therapies. Immunochemotherapy with rituximab-based regimens has become a well-established standard of care in the primary and relapsed disease settings. The role of hematopoietic stem cell transplantation in indolent lymphoma has been defined by the adoption of this therapy largely in the relapse setting because randomized trials in the first-line setting have not shown survival advantages. Allogeneic stem cell transplantation has the possibility for cure because of the potential for immunologic graft-versus-lymphoma effect, but there are significant concerns regarding nonrelapse mortality. Autologous stem cell transplantation offers a safe treatment platform, but relapse remains a significant issue. The role of transplantation in the current treatment landscape of immunochemotherapy has not been conclusively proven, and randomized trials are lacking. This review summarizes the current relevant data regarding transplantation in indolent non-Hodgkin lymphoma and highlights the issues relevant to clinicians in the field.
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Fenske TS, Hamadani M, Cohen JB, Costa LJ, Kahl BS, Evens AM, Hamlin PA, Lazarus HM, Petersdorf E, Bredeson C. Allogeneic Hematopoietic Cell Transplantation as Curative Therapy for Patients with Non-Hodgkin Lymphoma: Increasingly Successful Application to Older Patients. Biol Blood Marrow Transplant 2016; 22:1543-1551. [PMID: 27131863 DOI: 10.1016/j.bbmt.2016.04.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/21/2016] [Indexed: 12/31/2022]
Abstract
Non-Hodgkin lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with widely varying biological, histological, and clinical features. For the B cell NHLs, great progress has been made due to the addition of monoclonal antibodies and, more recently, other novel agents including B cell receptor signaling inhibitors, immunomodulatory agents, and proteasome inhibitors. Autologous hematopoietic cell transplantation (auto-HCT) offers the promise of cure or prolonged remission in some NHL patients. For some patients, however, auto-HCT may never be a viable option, whereas in others, the disease may progress despite auto-HCT. In those settings, allogeneic HCT (allo-HCT) offers the potential for cure. Over the past 10 to 15 years, considerable progress has been made in the implementation of allo-HCT, such that this approach now is a highly effective therapy for patients up to (and even beyond) age 75 years. Recent advances in conventional lymphoma therapy, peritransplantation supportive care, patient selection, and donor selection (including the use of alternative hematopoietic cell donors), has allowed broader application of allo-HCT to patients with NHL. As a result, an ever-increasing number of NHL patients over age 60 to 65 years stand to benefit from allo-HCT. In this review, we present data in support of the use of allo-HCT for patients with diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. These histologies account for a large majority of allo-HCTs performed for patients over age 60 in the United States. Where possible, we highlight available data in older patients. This body of literature strongly supports the concept that allo-HCT should be offered to fit patients well beyond age 65 and, accordingly, that this treatment should be covered by their insurance carriers.
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Affiliation(s)
- Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, Georgia
| | - Luciano J Costa
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brad S Kahl
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew M Evens
- Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Paul A Hamlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Hillard M Lazarus
- Division of Hematology-Oncology, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Effie Petersdorf
- Division of Medical Oncology, University of Washington School of Medicine, and Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christopher Bredeson
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute at University of Ottawa, Ottawa, Ontario, Canada
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Laport GG, Wu J, Logan B, Bachanova V, Hosing C, Fenske T, Longo W, Devine SM, Nademanee A, Gersten I, Horowitz M, Lazarus HM, Riches ML. Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and High-Dose Rituximab for Allogeneic Hematopoietic Cell Transplantation for Follicular Lymphoma: A Phase Two Multicenter Trial from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016; 22:1440-1448. [PMID: 27118571 DOI: 10.1016/j.bbmt.2016.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Allogeneic (allo) hematopoietic cell transplantation (HCT) can induce long-term remissions in chemosensitive relapsed follicular lymphoma (FL). The Blood and Marrow Transplant Clinical Trials Network conducted a multicenter phase 2 trial to examine the efficacy of alloHCT using reduced-intensity conditioning with rituximab (RTX) in multiply relapsed, chemosensitive FL. The primary endpoint was 2-year progression-free survival (PFS). The conditioning regimen consisted of fludarabine, cyclophosphamide, and high-dose RTX (FCR), in which 3 of the 4 doses of RTX were administered at a dose of 1 gm/m(2). Graft-versus-host disease (GVHD) prophylaxis was with tacrolimus and methotrexate. Sixty-five patients were enrolled and 62 were evaluable. Median age was 55 years (range, 29 to 74). This group was heavily pretreated: 77% had received ≥ 3 prior regimens, 32% had received ≥ 5 prior regimens, and 11% had received prior autologous HCT. Donors were HLA-matched siblings (n = 33) or HLA-matched unrelated adults (n = 29). No graft failures occurred. The overall response rate after HCT was 94% with 90% in complete remission (CR), including 24 patients not in CR before alloHCT. With a median follow-up of 47 months (range, 30 to 73), 3-year PFS and overall survival rates were 71% (95% confidence interval, 58% to 81%) and 82% (95% confidence interval, 70% to 90%), respectively. Three-year cumulative incidences of relapse/progression and nonrelapse mortality were 13% and 16%, respectively. Two-year cumulative incidences of grades 2 to 4 and grades 3 or 4 acute GVHD were 27% and 10%, respectively, and extensive chronic GVHD incidence was 55%. Serum RTX concentrations peaked at day +28 and remained detectable as late as 1 year in 59% of patients with available data. In conclusion, alloHCT with FCR conditioning confers high CR rates, a low incidence of relapse/progression, and excellent survival probabilities in heavily pretreated FL patients.
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Affiliation(s)
- Ginna G Laport
- Stanford University Medical Center, Stanford, California
| | - Juan Wu
- The EMMES Corporation, Rockville, Maryland
| | - Brent Logan
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Chitra Hosing
- University of Texas/MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | | | - Marcie L Riches
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
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Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas. Bone Marrow Transplant 2016; 51:654-62. [PMID: 26855152 DOI: 10.1038/bmt.2015.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/03/2015] [Accepted: 12/05/2015] [Indexed: 01/16/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry 'DRST'. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2- and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatment-sensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽42 years should be preferred if available.
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41
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Lunning MA, Migliacci JC, Hilden P, Devlin SM, Castro-Malaspina H, Giralt S, Perales MA, Zelenetz AD, Moskowitz CH, Sauter CS. The potential benefit of allogeneic over autologous transplantation in patients with very early relapsed and refractory follicular lymphoma with prior remission duration of ≤12 months. Br J Haematol 2016; 173:260-4. [PMID: 26847389 DOI: 10.1111/bjh.13947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
Early relapsed or refractory follicular lymphoma (FL) warrants consolidation with transplantation, though graft source modality remains controversial. We analysed the outcomes of 44 patients transplanted with either autologous or allogeneic graft sources in the post-rituximab era. No difference in event-free (EFS) or overall survival (OS) was observed between allogeneic (81% and 81%) and autologous transplantation (64% and 70%) at 3 years. There was a significant difference in EFS between allogeneic and autologous transplantation patients with previous remission duration of ≤12 months (80% and 42% at 3 years, P < 0·015). Very early relapsed FL may warrant consideration of allogeneic over autologous transplantation in the appropriate setting.
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Affiliation(s)
| | - Jocelyn C Migliacci
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick Hilden
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hugo Castro-Malaspina
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sergio Giralt
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Andrew D Zelenetz
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Craig H Moskowitz
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Craig S Sauter
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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42
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Freedman A. Follicular lymphoma: 2015 update on diagnosis and management. Am J Hematol 2015; 90:1171-8. [PMID: 26769125 DOI: 10.1002/ajh.24200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Follicular lymphoma is generally an indolent B cell lymphoproliferative disorder of transformed follicular center B cells. Follicular lymphoma (FL) is characterized by diffuse lymphoadenopathy, bone marrow involvement, splenomegaly, and less commonly other extranodal sites of involvement. In general, cytopenias can occur but constitutional symptoms of fever, night sweats, and weight loss are uncommon. DIAGNOSIS Diagnosis is based on histology of preferably a biopsy of a lymph node. Immunohistochemical staining is positive in virtually all cases for cell surface CD19, CD20, CD10, and monoclonal immunoglobulin, as well as cytoplasmic expression of bcl-2 protein. The overwhelming majority of cases have the characteristic t(14;18) translocation involving the IgH/bcl-2 genes. RISK STRATIFICATION The Follicular Lymphoma International Prognostic Index prognostic model for FL uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas > 4. The presence of 0, 1, 2, and ≥ 3 adverse factors defines low, intermediate, and high-risk disease. With the use of more modern therapies, outcomes have improved. RISK-ADAPTED THERAPY Observation continues to be adequate for asymptomatic patients with low bulk disease and no cytopenias, with no survival advantage for early treatment with either chemotherapy or rituximab alone. For patients needing therapy, most patients are treated with chemotherapy plus rituximab, which has improved response rates, duration of response and overall survival. Randomized studies have shown additional benefit for maintenance rituximab both following chemotherapy-rituximab and single agent rituximab. Experimental therapies as well as stem cell transplantation (SCT) are considered for recurrent disease.
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Affiliation(s)
- Arnold Freedman
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
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43
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Bhatt VR, Armitage JO. Autologous and allogeneic hematopoietic stem cell transplantation in follicular lymphoma. Expert Opin Biol Ther 2015; 16:57-66. [DOI: 10.1517/14712598.2016.1096341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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44
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van Besien K. Allografting versus Autografting for Follicular Lymphoma: An Ongoing Conundrum. Biol Blood Marrow Transplant 2015; 21:2035-2036. [PMID: 26463649 DOI: 10.1016/j.bbmt.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Koen van Besien
- Division of Hematology/Oncology, Bone Marrow and Stem Cell Transplant Program, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.
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45
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Jacobson CA, Freedman AS. Rethinking Prognosis and Therapy for Follicular Lymphoma. J Clin Oncol 2015; 33:2489-91. [DOI: 10.1200/jco.2015.62.3256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Caron A. Jacobson
- Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
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Klyuchnikov E, Bacher U, Kröger NM, Hari PN, Ahn KW, Carreras J, Bachanova V, Bashey A, Cohen JB, D'Souza A, Freytes CO, Gale RP, Ganguly S, Hertzberg MS, Holmberg LA, Kharfan-Dabaja MA, Klein A, Ku GH, Laport GG, Lazarus HM, Miller AM, Mussetti A, Olsson RF, Slavin S, Usmani SZ, Vij R, Wood WA, Maloney DG, Sureda AM, Smith SM, Hamadani M. Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors. Biol Blood Marrow Transplant 2015; 21:2091-2099. [PMID: 26253007 DOI: 10.1016/j.bbmt.2015.07.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 12/22/2022]
Abstract
This study was conducted to compare long-term outcomes in patients with refractory/relapsed grades 1 and 2 follicular lymphoma (FL) after allogeneic (allo) versus autologous (auto) hematopoietic cell transplantation (HCT) in the rituximab era. Adult patients with relapsed/refractory grades 1 and 2 FL undergoing first reduced-intensity allo-HCT or first autograft during 2000 to 2012 were evaluated. A total of 518 rituximab-treated patients were included. Allo-HCT patients were younger and more heavily pretreated, and more patients had advanced stage and chemoresistant disease. The 5-year adjusted probabilities, comparing auto-HCT versus allo-HCT groups for nonrelapse mortality (NRM) were 5% versus 26% (P < .0001); relapse/progression: 54% versus 20% (P < .0001); progression-free survival (PFS): 41% versus 58% (P < .001), and overall survival (OS): 74% versus 66% (P = .05). Auto-HCT was associated with a higher risk of relapse/progression beyond 5 months after HCT (relative risk [RR], 4.4; P < .0001) and worse PFS (RR, 2.9; P < .0001) beyond 11 months after HCT. In the first 24 months after HCT, auto-HCT was associated with improved OS (RR, .41; P < .0001), but beyond 24 months, it was associated with inferior OS (RR, 2.2; P = .006). A landmark analysis of patients alive and progression-free at 2 years after HCT confirmed these observations, showing no difference in further NRM between both groups, but there was significantly higher risk of relapse/progression (RR, 7.3; P < .0001) and inferior PFS (RR, 3.2; P < .0001) and OS (RR, 2.1; P = .04) after auto-HCT. The 10-year cumulative incidences of second hematological malignancies after allo-HCT and auto-HCT were 0% and 7%, respectively. Auto-HCT and reduced-intensity-conditioned allo-HCT as first transplantation approach can provide durable disease control in grades 1 and 2 FL patients. Continued disease relapse risk after auto-HCT translates into improved PFS and OS after allo-HCT in long-term survivors.
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Affiliation(s)
- Evgeny Klyuchnikov
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Ulrike Bacher
- Department for Hematology and Internal Oncology, Georg August University Göttingen, Göttingen, Germany
| | - Nicolaus M Kröger
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Veronika Bachanova
- Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - César O Freytes
- South Texas Veterans Health Care System and University of Texas Science Center San Antonio, San Antonio, San Antonio, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark S Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick NSW, Australia
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andreas Klein
- Divison of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Grace H Ku
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California, San Diego, San Diego, California
| | - Ginna G Laport
- Division of Bone Marrow Transplantation, Stanford Hospital and Clinics, Stanford, California
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, Texas
| | - Alberto Mussetti
- S.C. Ematologia e Trapianto Midollo Osseo, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Shimon Slavin
- The International Center for Cell Therapy and Cancer Immunotherapy, Tel Aviv, Israel
| | - Saad Z Usmani
- Department of Hematology, Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna M Sureda
- Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain; European Group for Blood and Marrow Transplantation
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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47
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Ansell SM. Non-Hodgkin Lymphoma: Diagnosis and Treatment. Mayo Clin Proc 2015; 90:1152-63. [PMID: 26250731 DOI: 10.1016/j.mayocp.2015.04.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphomas are lymphoid malignant neoplasms with diverse biological and clinical behavior. Patients typically present with persistent painless lymphadenopathy, but some patients may present with constitutional symptoms or with involvement of organs other than the lymphoid and hematopoietic system. An accurate diagnosis, careful staging of the disease, and identification of adverse prognostic factors form the basis of treatment selection. Patients commonly receive chemoimmunotherapy as initial treatment, and radiation therapy may be added if patients have early-stage disease. Most patients respond well to treatment, but relapses are frequent and additional therapies including stem cell transplant are often needed. Because many subtypes of lymphoma remain incurable with current management strategies, clinical trials are in progress to identify novel therapies with promising activity in this disease.
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48
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Yano S, Mori T, Kanda Y, Kato J, Nakaseko C, Fujisawa S, Tomita N, Sakai R, Shono K, Saitoh T, Aotsuka N, Kobayashi N, Saito T, Takahashi S, Kanamori H, Okamoto S. Favorable survival after allogeneic stem cell transplantation with reduced-intensity conditioning regimens for relapsed/refractory follicular lymphoma. Bone Marrow Transplant 2015; 50:1299-305. [DOI: 10.1038/bmt.2015.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/12/2015] [Accepted: 05/26/2015] [Indexed: 11/09/2022]
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49
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Arcaini L, Morello L, Tucci A, Rusconi C, Ladetto M, Rattotti S, Bonfichi M, Bottelli C, Gabutti C, Bernasconi P, Varettoni M, Gotti M, Troletti D, Guerrera ML, Fiaccadori V, Sciarra R, Ferretti VV, Alessandrino EP, Rossi G, Morra E. Autologous stem cell transplantation with in vivo purged progenitor cells shows long-term efficacy in relapsed/refractory follicular lymphoma. Am J Hematol 2015; 90:230-4. [PMID: 25502635 DOI: 10.1002/ajh.23919] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/24/2014] [Accepted: 12/08/2014] [Indexed: 11/06/2022]
Abstract
High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been shown effective in the control of relapsed/refractory follicular lymphoma. We evaluate the long-term outcome of patients with relapsed or refractory follicular lymphoma treated with ASCT with in vivo purged progenitors cells. We report the long-term results of a prospective multicenter phase 2 trial on 124 relapsed/refractory follicular lymphoma patients treated with a program of anthracycline-based debulking chemotherapy, immunochemotherapy, mobilization of in vivo purged PBSC followed by ASCT. Median age was 52 years; 14% of patients had grade 3A histology. Debulking chemotherapy produced CR in 16% and PR in 71%, while 13% of patients progressed. After rituximab, cyclophosphamide, vincristine, prednisone (R-COP), CR was obtained in 60% and PR in 35%; 118 patients successfully mobilized PBSC and 117 proceeded to ASCT. The harvest in all the 32 molecularly informative patients was bcl-2 negative. TRM was 0%. The 5-year PFS was 54% and the 5-year OS was 83%. After a median f-up of 6.7 years (range 1.5-13.6), 54% are still in CR. These data show that prolonged PFS is achievable in relapsed/refractory patients with high dose autologous transplantation of in vivo purged progenitor cells.
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Affiliation(s)
- Luca Arcaini
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Lucia Morello
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | | | - Chiara Rusconi
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
| | - Marco Ladetto
- Division of Hematology; Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo; Alessandria
| | - Sara Rattotti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Maurizio Bonfichi
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Cristina Gabutti
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
| | - Paolo Bernasconi
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Marzia Varettoni
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Manuel Gotti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Daniela Troletti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Maria Luisa Guerrera
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Roberta Sciarra
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | - Virginia Valeria Ferretti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Emilio Paolo Alessandrino
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Enrica Morra
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
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50
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Kritharis A, Sharma J, Evens AM. Current therapeutic strategies and new treatment paradigms for follicular lymphoma. Cancer Treat Res 2015; 165:197-226. [PMID: 25655611 DOI: 10.1007/978-3-319-13150-4_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that remains an incurable disease for most patients. It is responsive to a variety of different treatments, however it follows a pattern of relapsing and remitting disease. Traditional therapeutic options for patients with untreated FL include expectant observation for asymptomatic and low tumor burden and multiagent cytotoxic chemotherapy for symptomatic and/or high tumor burden. Biologics have become an integral part of therapy with agents that target B lymphocytes, including monoclonal anti-CD20 antibodies and radiolabeled anti-CD20 antibodies. Treatment response to cytotoxic and biologic therapy is high initially; however, with subsequent treatments, response rate and remission duration typically decline and cumulative toxicities increase. The identification of novel targeted agents, use of stem cell transplantation, and new treatment combinations provide the opportunity to enhance patient outcomes. In this review, we critically examine standard treatment strategies for patients with newly diagnosed and relapsed or refractory FL and discuss established and emerging novel therapeutic approaches.
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Affiliation(s)
- Athena Kritharis
- Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
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