Impact of the use of autologous stem cell transplantation at first relapse both in naive and previously rituximab exposed follicular lymphoma patients treated in the GELA/GOELAMS FL2000 study

Abstract

Background: We analyzed detailed characteristics and salvage treatment in 175 follicular lymphoma patients from the FL2000 study who were in progression after first-line therapy with or without addition of rituximab to chemotherapy and interferon.

Design and methods: The impact of using autologous stem cell transplantation and/or rituximab administration at first progression was investigated, taking into account initial therapy. With a median follow up of 31 months, 3-year event free and overall survival rates after progression were 50% (95%CI 42-58%) and 72% (95%CI 64-78%), respectively.

Results: The 3-year event free rate of rituximab re-treated patients (n=112) was 52% (95%CI 41-62%) versus 40% (95%CI 24-55%) for those not receiving rituximab second line (n=53) (P=0.075). There was a significant difference in 3-year overall survival between patients receiving autologous stem cell transplantation and those not: 92% (95%CI 78-97%) versus 63% (95%CI 51-72%) (P=0.0003), respectively. In multivariate analysis, both autologous stem cell transplantation and period of progression/relapse affected event free and overall survival.

Conclusions: Regardless of front-line rituximab exposure, this study supports incorporating autologous stem cell transplantation in the therapeutic approach at first relapse for follicular lymphoma patients.

Figures

Figure 1.

Patient outcome calculated from first progression (n=175). (A) Event-free survival; the 3- and 5-year EFS rates are 50% (95% CI; 42–58%) and 26% (95% CI; 14–39%), respectively. (B) Overall survival; the 3- and 5-year OS rates are 72% (95% CI; 64–78%) and 52% (95% CI; 36–66%), respectively.

Figure 2.

Outcome of patients (under the age of 70 years) according to transplantation at first progression: ----transplanted patients (n=42); —— non-transplanted patients (n=111). (A) Event-free survival (P=0.0005). (B) Overall survival (P=0.0003).

Figure 3.

Outcome of patients (under the age of 70 years) according to front-line therapy and use of transplantation at first progression: ---- transplanted patients and —— non-transplanted patients. (A) Event-free survival of patients failing CHVP-I (P=0.002). (B) Overall survival of patients failing CHVP-I (P=0.005). (C) Event-free survival of patients failing R-CHVP-I (P=0.052). (D) Overall survival of patients failing R-CHVP-I (P=0.052).

Figure 4.

Outcome of patients (under the age of 70 years) according to progression period and use of transplantation at first progression: ---- transplanted patients and —— non-transplanted patients. (A) Event-free survival of primary refractory patients (P=0.002). (B) Event-free survival of patients who progressed or relapsed after first-line treatment completion: (P=0.011).