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COMPLETE REMISSION STATUS BEFORE AUTOLOGOUS STEM CELL TRANSPLANTATION AS PROGNOSTIC FACTOR IN PATIENTS WITH NON-HODGKIN LYMPHOMA
Author(s):
Ana Pinto
,
Ana Pinto
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal
Adriana Roque
,
Adriana Roque
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Faculty of Medicine and CIMAGO,University of Coimbra,Coimbra,Portugal
Marília Gomes
,
Marília Gomes
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal
Emília Cortesão
,
Emília Cortesão
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Faculty of Medicine and CIMAGO,University of Coimbra,Coimbra,Portugal
Ana Espadana
,
Ana Espadana
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal
Ana Bela Sarmento
,
Ana Bela Sarmento
Affiliations:
Faculty of Medicine and CIMAGO,University of Coimbra,Coimbra,Portugal;Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal
Catarina Geraldes
,
Catarina Geraldes
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Faculty of Medicine and CIMAGO,University of Coimbra,Coimbra,Portugal
M Letícia Ribeiro
M Letícia Ribeiro
Affiliations:
Clinical Hematology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal
(Abstract release date: 05/18/17) EHA Library. Pinto A. 05/18/17; 182897; PB2184
Ms. Ana Luisa Pinto
Ms. Ana Luisa Pinto
Contributions
PDF Abstract
Abstract

Abstract: PB2184

Type: Publication Only

Background

High dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT) is commonly used for treatment of relapsed or refractory non-Hodgkin's lymphoma (NHL), as well as for first-remission consolidation in patients with mantle cell lymphoma. Disease status before ASCT is variable and is unclear whether complete response before ASCT or after ASCT correlates with better survival.

Aims

To evaluate the prognostic effect of disease status before ASCT - complete remission (CR) vs partial remission (PR) - in a cohort of patients with NHL.

Methods

Retrospective analysis of patients with NHL treated with HDT and ASCT between 2007 and 2016 in a single institution. All patients received peripheral blood stem cell support after conditioning with BEAM regimen (carmustine 300mg/m2, etoposide 800mg/m2, Ara-c 1600mg/m2 and melphalan140 mg/m2). Response was assessed according to The Lugano Classification. The Kaplan-Meier method was used to estimate progression free survival (PFS) and overall survival (OS) and comparison between risk groups was performed by using the log-rank test. Univariate analysis was performed and significant predictors at the level of 0.05 were used to adjust a multivariate Cox regression model.

Results
We included 83 NHL patients, mainly males (72.3%) with a median age at diagnosis of 51 years (18-65). The most prevalent histological subtypes were diffuse large B cell lymphoma (53.0%), mantle cell lymphoma (36.1%) and follicular lymphoma (15.7%). The median number of therapeutic lines was 2 (1-5). Patients with diffuse large B cell lymphoma and follicular lymphoma were mainly treated with R-CHOP/R-CVP (82.5%) at first-line. For those who did not achieve a CR or relapsed after first-line treatment, (R)-ESHAP/DHAP/ICE (78.8%) was performed as second-line followed by ASCT as salvage therapy in order to achieve and consolidate CR. The majority of patients with mantle cell lymphoma received R-CHOP/R-DHAP (55.0%) followed by consolidation with ASCT in first remission. With a median follow-up time from ASCT of 39.66 months (0.3-117.6), OS at 2 and 5 years was 84.8% and 74.5% and PFS was 76.8% and 58.2%, respectively. Before ASCT, 60 patients (72.3%) were in CR and 23 (27.7%) were in PR. After ACST, 4 patients were not assessed for response due to early death by toxicity. Of the remaining, 70 (88.6%) achieved a CR, 4 (5.1%) a PR and 5 (6.3%) failed to respond. Patients in CR before ASCT presented significantly longer PFS compared with those in PR (107.9 vs 44.0 months, p=0.01). Besides that, patients that obtained CR after ASCT also had longer OS and PFS compared with those in PR (107.9 vs 8.0 and 107.9 vs 7.3 months, p<0.001). However, these patients had significantly lower PFS compared to patients that continued in CR after ASCT (45.3 vs 107.9 months, p=0.041). Univariate analysis indicated that remission status pre-ASCT (CR vs PR) is a significant predictor of PFS after ASCT (HR 0.39; 95% CI 0.19-0.82, p=0.013). Multivariate Cox regression model showed that this factor retains prognostic value after adjustment for age, histological subtype, Ann Arbor stage and number of previous lines of treatment.

Conclusion

Our results highlight the relevance of the obtained CR after ASCT in the OS. Furthermore, we conclude that patients with NHL who are in CR before ASCT have a better PFS than those in PR before ASCT. Additionally, continued CR after ASCT may also be an important prognostic factor. Our results suggest that the use of more effective induction regimens in order to improve initial response may be advantageous in terms of clinical benefits post-ASCT.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Complete Remission, Autologous hematopoietic stem cell transplantation, Prognostic factor, Non-Hodgkin's lymphoma

Abstract: PB2184

Type: Publication Only

Background

High dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT) is commonly used for treatment of relapsed or refractory non-Hodgkin's lymphoma (NHL), as well as for first-remission consolidation in patients with mantle cell lymphoma. Disease status before ASCT is variable and is unclear whether complete response before ASCT or after ASCT correlates with better survival.

Aims

To evaluate the prognostic effect of disease status before ASCT - complete remission (CR) vs partial remission (PR) - in a cohort of patients with NHL.

Methods

Retrospective analysis of patients with NHL treated with HDT and ASCT between 2007 and 2016 in a single institution. All patients received peripheral blood stem cell support after conditioning with BEAM regimen (carmustine 300mg/m2, etoposide 800mg/m2, Ara-c 1600mg/m2 and melphalan140 mg/m2). Response was assessed according to The Lugano Classification. The Kaplan-Meier method was used to estimate progression free survival (PFS) and overall survival (OS) and comparison between risk groups was performed by using the log-rank test. Univariate analysis was performed and significant predictors at the level of 0.05 were used to adjust a multivariate Cox regression model.

Results
We included 83 NHL patients, mainly males (72.3%) with a median age at diagnosis of 51 years (18-65). The most prevalent histological subtypes were diffuse large B cell lymphoma (53.0%), mantle cell lymphoma (36.1%) and follicular lymphoma (15.7%). The median number of therapeutic lines was 2 (1-5). Patients with diffuse large B cell lymphoma and follicular lymphoma were mainly treated with R-CHOP/R-CVP (82.5%) at first-line. For those who did not achieve a CR or relapsed after first-line treatment, (R)-ESHAP/DHAP/ICE (78.8%) was performed as second-line followed by ASCT as salvage therapy in order to achieve and consolidate CR. The majority of patients with mantle cell lymphoma received R-CHOP/R-DHAP (55.0%) followed by consolidation with ASCT in first remission. With a median follow-up time from ASCT of 39.66 months (0.3-117.6), OS at 2 and 5 years was 84.8% and 74.5% and PFS was 76.8% and 58.2%, respectively. Before ASCT, 60 patients (72.3%) were in CR and 23 (27.7%) were in PR. After ACST, 4 patients were not assessed for response due to early death by toxicity. Of the remaining, 70 (88.6%) achieved a CR, 4 (5.1%) a PR and 5 (6.3%) failed to respond. Patients in CR before ASCT presented significantly longer PFS compared with those in PR (107.9 vs 44.0 months, p=0.01). Besides that, patients that obtained CR after ASCT also had longer OS and PFS compared with those in PR (107.9 vs 8.0 and 107.9 vs 7.3 months, p<0.001). However, these patients had significantly lower PFS compared to patients that continued in CR after ASCT (45.3 vs 107.9 months, p=0.041). Univariate analysis indicated that remission status pre-ASCT (CR vs PR) is a significant predictor of PFS after ASCT (HR 0.39; 95% CI 0.19-0.82, p=0.013). Multivariate Cox regression model showed that this factor retains prognostic value after adjustment for age, histological subtype, Ann Arbor stage and number of previous lines of treatment.

Conclusion

Our results highlight the relevance of the obtained CR after ASCT in the OS. Furthermore, we conclude that patients with NHL who are in CR before ASCT have a better PFS than those in PR before ASCT. Additionally, continued CR after ASCT may also be an important prognostic factor. Our results suggest that the use of more effective induction regimens in order to improve initial response may be advantageous in terms of clinical benefits post-ASCT.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Complete Remission, Autologous hematopoietic stem cell transplantation, Prognostic factor, Non-Hodgkin's lymphoma

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