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Disease Progression is Major Cause of Treatment Failure After HCT in Transformed FL
A retrospective study has characterized the outcomes of patients with transformed follicular lymphoma (tFL) who underwent hematopoietic cell transplantation (HCT; Hematol Oncol. 2021 Dec; Epub ahead of print.)
Between 2000 and 2017, the study included 74 patients who underwent autologous (auto-HCT, n = 23) or allogeneic (allo-HCT, n = 51) HCT, according to Hanae Ida, MD, Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan, and co-authors.
Compared with the allo-HCT group, the auto-HCT group experienced fewer systemic regimens before HCT (median 2 versus 5, P = .001). Every patient (100%) from the allo-HCT group had chemosensitive disease at HCT, versus 82% from the auto-HCT group (P = .05). Age, sex, and HCT-specific comorbidity index were similar between both groups.
At a median follow up of 5.8 years, the 5-year probability of progression-free survival (PFS) was 64% after auto-HCT and 55% after allo-HCT (P = .21). The 5-year cumulative incidence of non-relapse mortality was 0% after auto-HCT, and 9.5% after allo-HCT (P = .062). The 5-year cumulative incidence of disease progression was the same between both groups (36% for both, P = .88).
The study also confirmed there is an association between low-dose anti-thymocyte globulin use and outcomes after allo-HCT. In the allo-HCT group, the use of low-dose anti-thymocyte globulin was linked to a lower incidence of severe acute graft-versus-host-disease (GVHD), but not to an increased risk of mortality or disease progression.
More than half of patients with early phase chemosensitive tFL, and about half with advanced-phase tFL achieved long-term PFS with auto- and allo-HCT, respectively.
“Disease progression was the major cause of treatment failure after both types of HCT. Further strategies are needed to reduce the risk of disease progression,” concluded Dr Ida et al.—Emily Bader
