ANALYSIS OF SECONDARY NEOPLASIAS AFTER HIGH DOSE THERAPY SUPPORTED BY AUTOLOGOUS STEM CELL TRANSPLANTATION IN FOLICULAR LYMPHOMA PATIENTS. A LONG TERM FOLLOW-UP ANALYSIS FROM THE GELTAMO REGISTRY.
(Abstract release date: 05/19/16)
EHA Library. Jiménez Ubieto A. 06/11/16; 135197; S441
Ms. Ana Jiménez Ubieto
Contributions
Contributions
Abstract
Abstract: S441
Type: Oral Presentation
Presentation during EHA21: On Saturday, June 11, 2016 from 12:30 - 12:45
Location: Auditorium 1
Background
High dose therapy supported by autologous stem cell transplantation (HDT/ASCT) has been a treatment frequently indicated in follicular lymphoma (FL) patients and has contributed to modify the natural history of the disease, however secondary neoplasia is one of the concerns after HDT/ASCT with a reported incidence very variable among studies due in part to cohort different in terms of age, pre-ASCT treatments, used of total body irradiation (TBI)-based conditioning regimen or length of follow-up rather than to the procedure itself
Aims
To evaluate the cumulative incidence and characteristics of myelodysplastic syndromes and acute myeloid leukemia (sMDS/sAML) and solid tumors after HDT/ASCT in a very long-term follow-up analysis of FL patients
Methods
A total of 655 FL patients reported to the Spanish GELTAMO registry and intensified with HDT/ASCT between 1989 and 2007 were analyzed. Baseline characteristics and therapeutic-related data are listed in the table. Standardized Incidence Ratios (SIR) were calculated to assess the risk of a second malignancy by dividing the number of observed second malignancies with the number of expected sex matched incidence using the 2008 crudes rates in the Spanish population (M.J Sánchez, Annals oncology 2010)
Results
At a median follow-up of 12 years from HDT/ASCT and 14.2 years from diagnosis of FL the median OS were 21.3 years from HDT/ASCT and 22.6 years from the time of FL diagnosis. Of the 645 evaluable patients; 80 (12.5%) developed a second malignancy: solid tumors (38 cases; 47.5%; of them 5 were skin cancers), sMDS/sAML (34 cases; 42.5%), ALL (2 cases), CML (1 case), Hodgkin lymphoma (1 case) and not specified (4 cases). The accumulated incidence at 5, 10 and 15 years was 1.8%, 3.5% and 4.9% for solid tumors and 2.6%, 4.3% and 5% for sMDS/sAML, respectively. sMDS/sAML and solid tumors were documented with a median time of occurrence since HDT/ASCT of 4.2 years (0.3-15.5) and 8.3 years (0.5-24.4), respectively. The SIR for second neoplasia was 2.8.Male sex (P=.1) and the use of BM as stem cell source (P=.1) tended to be associated with an increased number of second neoplasia. There were no differences according to the use of anthracycline, fludarabine or rituximab previously to HDT/ASCT, number of therapy lines before HDT/ASCT, time from diagnosis to HDT/ASCT, status of the disease at HDT/ASCT or conditioning regimen. Median OS for patients with second neoplasia is 11.8 years from the time of FL diagnosis, 9.4 years from ASCT [14.5 y. for solid tumors and 8 y. for sMDS/sAML (P=.01)] and 1.4 years from the time of diagnosis of second neoplasia [2.7 y. for solid tumors and 1.3 y. for sMDS/sAML (P=.01)], respectively
Conclusion
Our results, from the longest follow-up study in FL including a large number of cases from the rituximab era, indicate that FL patients undergoing and ASCT are at an increased risk of developing a second malignancy, however, the incidence is not higher than that reported in other series without transplantation (Rummel, Lancet 2016; Ardeshna, Lancet 2003). Low percentage of patients conditioned with TBI and a considerable number of patients been transplanted soon during the disease, could explain these good results. Once a secondary neoplasia is diagnosed prognosis is dismal, and consequently a carefully selection of patients candidates to ASCT is necessary.For all that, we suggest that, given the favorable survival obtained by HDT/ASCT makes not evident to what extent incidence of secondary neoplasia will diminish the benefit of HDT/ASCT in FL.
Session topic: Follicular and Mantle Cell Lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Follicular lymphoma, Second malignancy, Survival
Type: Oral Presentation
Presentation during EHA21: On Saturday, June 11, 2016 from 12:30 - 12:45
Location: Auditorium 1
Background
High dose therapy supported by autologous stem cell transplantation (HDT/ASCT) has been a treatment frequently indicated in follicular lymphoma (FL) patients and has contributed to modify the natural history of the disease, however secondary neoplasia is one of the concerns after HDT/ASCT with a reported incidence very variable among studies due in part to cohort different in terms of age, pre-ASCT treatments, used of total body irradiation (TBI)-based conditioning regimen or length of follow-up rather than to the procedure itself
Aims
To evaluate the cumulative incidence and characteristics of myelodysplastic syndromes and acute myeloid leukemia (sMDS/sAML) and solid tumors after HDT/ASCT in a very long-term follow-up analysis of FL patients
Methods
A total of 655 FL patients reported to the Spanish GELTAMO registry and intensified with HDT/ASCT between 1989 and 2007 were analyzed. Baseline characteristics and therapeutic-related data are listed in the table. Standardized Incidence Ratios (SIR) were calculated to assess the risk of a second malignancy by dividing the number of observed second malignancies with the number of expected sex matched incidence using the 2008 crudes rates in the Spanish population (M.J Sánchez, Annals oncology 2010)
Results
At a median follow-up of 12 years from HDT/ASCT and 14.2 years from diagnosis of FL the median OS were 21.3 years from HDT/ASCT and 22.6 years from the time of FL diagnosis. Of the 645 evaluable patients; 80 (12.5%) developed a second malignancy: solid tumors (38 cases; 47.5%; of them 5 were skin cancers), sMDS/sAML (34 cases; 42.5%), ALL (2 cases), CML (1 case), Hodgkin lymphoma (1 case) and not specified (4 cases). The accumulated incidence at 5, 10 and 15 years was 1.8%, 3.5% and 4.9% for solid tumors and 2.6%, 4.3% and 5% for sMDS/sAML, respectively. sMDS/sAML and solid tumors were documented with a median time of occurrence since HDT/ASCT of 4.2 years (0.3-15.5) and 8.3 years (0.5-24.4), respectively. The SIR for second neoplasia was 2.8.Male sex (P=.1) and the use of BM as stem cell source (P=.1) tended to be associated with an increased number of second neoplasia. There were no differences according to the use of anthracycline, fludarabine or rituximab previously to HDT/ASCT, number of therapy lines before HDT/ASCT, time from diagnosis to HDT/ASCT, status of the disease at HDT/ASCT or conditioning regimen. Median OS for patients with second neoplasia is 11.8 years from the time of FL diagnosis, 9.4 years from ASCT [14.5 y. for solid tumors and 8 y. for sMDS/sAML (P=.01)] and 1.4 years from the time of diagnosis of second neoplasia [2.7 y. for solid tumors and 1.3 y. for sMDS/sAML (P=.01)], respectively
Conclusion
Our results, from the longest follow-up study in FL including a large number of cases from the rituximab era, indicate that FL patients undergoing and ASCT are at an increased risk of developing a second malignancy, however, the incidence is not higher than that reported in other series without transplantation (Rummel, Lancet 2016; Ardeshna, Lancet 2003). Low percentage of patients conditioned with TBI and a considerable number of patients been transplanted soon during the disease, could explain these good results. Once a secondary neoplasia is diagnosed prognosis is dismal, and consequently a carefully selection of patients candidates to ASCT is necessary.For all that, we suggest that, given the favorable survival obtained by HDT/ASCT makes not evident to what extent incidence of secondary neoplasia will diminish the benefit of HDT/ASCT in FL.
Session topic: Follicular and Mantle Cell Lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Follicular lymphoma, Second malignancy, Survival
Abstract: S441
Type: Oral Presentation
Presentation during EHA21: On Saturday, June 11, 2016 from 12:30 - 12:45
Location: Auditorium 1
Background
High dose therapy supported by autologous stem cell transplantation (HDT/ASCT) has been a treatment frequently indicated in follicular lymphoma (FL) patients and has contributed to modify the natural history of the disease, however secondary neoplasia is one of the concerns after HDT/ASCT with a reported incidence very variable among studies due in part to cohort different in terms of age, pre-ASCT treatments, used of total body irradiation (TBI)-based conditioning regimen or length of follow-up rather than to the procedure itself
Aims
To evaluate the cumulative incidence and characteristics of myelodysplastic syndromes and acute myeloid leukemia (sMDS/sAML) and solid tumors after HDT/ASCT in a very long-term follow-up analysis of FL patients
Methods
A total of 655 FL patients reported to the Spanish GELTAMO registry and intensified with HDT/ASCT between 1989 and 2007 were analyzed. Baseline characteristics and therapeutic-related data are listed in the table. Standardized Incidence Ratios (SIR) were calculated to assess the risk of a second malignancy by dividing the number of observed second malignancies with the number of expected sex matched incidence using the 2008 crudes rates in the Spanish population (M.J Sánchez, Annals oncology 2010)
Results
At a median follow-up of 12 years from HDT/ASCT and 14.2 years from diagnosis of FL the median OS were 21.3 years from HDT/ASCT and 22.6 years from the time of FL diagnosis. Of the 645 evaluable patients; 80 (12.5%) developed a second malignancy: solid tumors (38 cases; 47.5%; of them 5 were skin cancers), sMDS/sAML (34 cases; 42.5%), ALL (2 cases), CML (1 case), Hodgkin lymphoma (1 case) and not specified (4 cases). The accumulated incidence at 5, 10 and 15 years was 1.8%, 3.5% and 4.9% for solid tumors and 2.6%, 4.3% and 5% for sMDS/sAML, respectively. sMDS/sAML and solid tumors were documented with a median time of occurrence since HDT/ASCT of 4.2 years (0.3-15.5) and 8.3 years (0.5-24.4), respectively. The SIR for second neoplasia was 2.8.Male sex (P=.1) and the use of BM as stem cell source (P=.1) tended to be associated with an increased number of second neoplasia. There were no differences according to the use of anthracycline, fludarabine or rituximab previously to HDT/ASCT, number of therapy lines before HDT/ASCT, time from diagnosis to HDT/ASCT, status of the disease at HDT/ASCT or conditioning regimen. Median OS for patients with second neoplasia is 11.8 years from the time of FL diagnosis, 9.4 years from ASCT [14.5 y. for solid tumors and 8 y. for sMDS/sAML (P=.01)] and 1.4 years from the time of diagnosis of second neoplasia [2.7 y. for solid tumors and 1.3 y. for sMDS/sAML (P=.01)], respectively
Conclusion
Our results, from the longest follow-up study in FL including a large number of cases from the rituximab era, indicate that FL patients undergoing and ASCT are at an increased risk of developing a second malignancy, however, the incidence is not higher than that reported in other series without transplantation (Rummel, Lancet 2016; Ardeshna, Lancet 2003). Low percentage of patients conditioned with TBI and a considerable number of patients been transplanted soon during the disease, could explain these good results. Once a secondary neoplasia is diagnosed prognosis is dismal, and consequently a carefully selection of patients candidates to ASCT is necessary.For all that, we suggest that, given the favorable survival obtained by HDT/ASCT makes not evident to what extent incidence of secondary neoplasia will diminish the benefit of HDT/ASCT in FL.
Session topic: Follicular and Mantle Cell Lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Follicular lymphoma, Second malignancy, Survival
Type: Oral Presentation
Presentation during EHA21: On Saturday, June 11, 2016 from 12:30 - 12:45
Location: Auditorium 1
Background
High dose therapy supported by autologous stem cell transplantation (HDT/ASCT) has been a treatment frequently indicated in follicular lymphoma (FL) patients and has contributed to modify the natural history of the disease, however secondary neoplasia is one of the concerns after HDT/ASCT with a reported incidence very variable among studies due in part to cohort different in terms of age, pre-ASCT treatments, used of total body irradiation (TBI)-based conditioning regimen or length of follow-up rather than to the procedure itself
Aims
To evaluate the cumulative incidence and characteristics of myelodysplastic syndromes and acute myeloid leukemia (sMDS/sAML) and solid tumors after HDT/ASCT in a very long-term follow-up analysis of FL patients
Methods
A total of 655 FL patients reported to the Spanish GELTAMO registry and intensified with HDT/ASCT between 1989 and 2007 were analyzed. Baseline characteristics and therapeutic-related data are listed in the table. Standardized Incidence Ratios (SIR) were calculated to assess the risk of a second malignancy by dividing the number of observed second malignancies with the number of expected sex matched incidence using the 2008 crudes rates in the Spanish population (M.J Sánchez, Annals oncology 2010)
Results
At a median follow-up of 12 years from HDT/ASCT and 14.2 years from diagnosis of FL the median OS were 21.3 years from HDT/ASCT and 22.6 years from the time of FL diagnosis. Of the 645 evaluable patients; 80 (12.5%) developed a second malignancy: solid tumors (38 cases; 47.5%; of them 5 were skin cancers), sMDS/sAML (34 cases; 42.5%), ALL (2 cases), CML (1 case), Hodgkin lymphoma (1 case) and not specified (4 cases). The accumulated incidence at 5, 10 and 15 years was 1.8%, 3.5% and 4.9% for solid tumors and 2.6%, 4.3% and 5% for sMDS/sAML, respectively. sMDS/sAML and solid tumors were documented with a median time of occurrence since HDT/ASCT of 4.2 years (0.3-15.5) and 8.3 years (0.5-24.4), respectively. The SIR for second neoplasia was 2.8.Male sex (P=.1) and the use of BM as stem cell source (P=.1) tended to be associated with an increased number of second neoplasia. There were no differences according to the use of anthracycline, fludarabine or rituximab previously to HDT/ASCT, number of therapy lines before HDT/ASCT, time from diagnosis to HDT/ASCT, status of the disease at HDT/ASCT or conditioning regimen. Median OS for patients with second neoplasia is 11.8 years from the time of FL diagnosis, 9.4 years from ASCT [14.5 y. for solid tumors and 8 y. for sMDS/sAML (P=.01)] and 1.4 years from the time of diagnosis of second neoplasia [2.7 y. for solid tumors and 1.3 y. for sMDS/sAML (P=.01)], respectively
Conclusion
Our results, from the longest follow-up study in FL including a large number of cases from the rituximab era, indicate that FL patients undergoing and ASCT are at an increased risk of developing a second malignancy, however, the incidence is not higher than that reported in other series without transplantation (Rummel, Lancet 2016; Ardeshna, Lancet 2003). Low percentage of patients conditioned with TBI and a considerable number of patients been transplanted soon during the disease, could explain these good results. Once a secondary neoplasia is diagnosed prognosis is dismal, and consequently a carefully selection of patients candidates to ASCT is necessary.For all that, we suggest that, given the favorable survival obtained by HDT/ASCT makes not evident to what extent incidence of secondary neoplasia will diminish the benefit of HDT/ASCT in FL.
Session topic: Follicular and Mantle Cell Lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Follicular lymphoma, Second malignancy, Survival
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