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Post-Transplant Ibrutinib Associated With Longer Survival in Twice-Relapsed WM
Almost half (46%) of post-relapse Waldenstrom macroglobulinemia (WM) patients relapse again following autologous hematopoietic cell transplantation (auto-HCT), according to findings from a recent study. The median post-relapse overall survival (PR-OS) was significantly longer in patients who received ibrutinib in the post-transplant setting.
WM is a rare B-cell lymphoproliferative malignancy, explained Sairah Ahmed, MD.
“While registry data has shown a benefit for auto-HCT in relapsed WM, there is a paucity of data on outcomes of patients relapsing after auto-HCT,” wrote Dr Ahmed, Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, and co-authors.
The researchers analyzed data from WM patients throughout 5 academic centers in the US. The primary endpoint was PR-OS. Secondary endpoints were to identify factors prognostic of PR-OS.
Of the 48 adult patients with relapsed/refractory (R/R) WM who underwent auto-HCT between 2007 and 2017, 22 experienced relapse.
PR-OS of relapsed WM patients after auto-HCT (n = 22) was not reached (95% confidence interval [CI], 17.5 months-NR). Among patients who relapsed <1 year versus ≥1 year from auto-HCT, the median PR-OS was 18.4 months (95% CI, 0.8-NR) months and NR (95% CI, 17.5-NR), respectively (P = 0.06).
The median PR-OS was significantly longer in patients who received ibrutinib in the post-transplant setting compared to those who did not (NR vs. 18.4 months; 95% CI, 9.1-NR; P = 0.02).
On univariable analysis, the presence of complex karyotype (RR = 4.87; 95% CI, 1.22-19.53) and a higher number of prior lines of therapy (RR = 1.81; 95% CI, 1.23-2.67) were associated with a significantly higher risk of relapse.
“Of note, disease status at the time of transplant, CR/VGPR versus partial remission did not appear to impact PR-OS,” the authors wrote.
