Contributions
Abstract: PB2468
Type: Publication Only
Background
Autologous stem cell transplantation (ASCT) is currently an important therapeutic strategy. It is used as a consolidation therapy after high-dose chemotherapy in patients with aggressive non-Hodgkin's lymphoma (aNHL). The timing for transplantation depends not only on the lymphoma subtype but also on the disease status prior to the transplant, being indicated in patients with first chemosensitive relapse of aNHL after reaching partial (PR) or complete (CR) responses. However, clinical experience seems to show a worst outcome in patients with PR prior to ASCT, wondering wether the intensification of the chemotherapy regimen (until achieving CR) should be an option.
Aims
To compare the outcome of patients with aNHL in PR versus CR prior to autologous stem cell transplantation.
Methods
Retrospective longitudinal observational study of patients submitted to ASCT, from january 2007 to july 2017, in a single Portuguese institution. Statistical analysis was performed recurring to descriptive statistics and survival analysis using the Kaplan-Meier method, stratified by Log-Rank.
Results
We analyzed a sample of 76 patients with a median age at diagnosis of 46 years (17-64 years) and 53 (69.7%) were male. This population included several types of aNHL particularly Diffuse large B-cell lymphoma (DLBCL) n=46 (60.5%), High grade B- cell lymphomas, NOS n = 3 (3.9%), Mantle cell lymphoma (MCL) n = 22 (28.9%) and T-cell lymphomas n = 5 (6.6%). Patients were treated with a median of 2 therapeutic lines (range 1-4) and had a ECOG ≤1, prior to ASCT. The response assessments after day 100, was statistically significant (p<0.001) favoured the transplant, from the 17 patients with PR prior to ASCT, 12 achieved CR.
With a median follow-up of 74 months, we observed no statistically significant difference in the median overall survival (OS) of the entire study population, however, in subgroup analysis by lymphoma subtype there was a significant difference in the OS of patients with DLBCL (PR vs CR: 106m vs NR; p =0.003).
Twenty patients relapsed after ASCT, the median time until relapse was 46 months. Progression-free survival (PFS) of the entire cohort, defined from the time of ASCT to the time of relapse, revealed lower time to relapse in patients with PR prior to ASCT compared to patients in CR (86 months vs 135 months; p = 0.01).
Conclusion
Patients with DLBCL transplanted in PR after high dose chemotherapy, had a lower overall survival compared to the CR group. This suboptimal prognosis raises the issue whether chemotherapy should be optimized prior to consolidation with ASCT.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous stem cell collection, Non-Hodgkin's lymphoma, Relapsed lymphoma
Abstract: PB2468
Type: Publication Only
Background
Autologous stem cell transplantation (ASCT) is currently an important therapeutic strategy. It is used as a consolidation therapy after high-dose chemotherapy in patients with aggressive non-Hodgkin's lymphoma (aNHL). The timing for transplantation depends not only on the lymphoma subtype but also on the disease status prior to the transplant, being indicated in patients with first chemosensitive relapse of aNHL after reaching partial (PR) or complete (CR) responses. However, clinical experience seems to show a worst outcome in patients with PR prior to ASCT, wondering wether the intensification of the chemotherapy regimen (until achieving CR) should be an option.
Aims
To compare the outcome of patients with aNHL in PR versus CR prior to autologous stem cell transplantation.
Methods
Retrospective longitudinal observational study of patients submitted to ASCT, from january 2007 to july 2017, in a single Portuguese institution. Statistical analysis was performed recurring to descriptive statistics and survival analysis using the Kaplan-Meier method, stratified by Log-Rank.
Results
We analyzed a sample of 76 patients with a median age at diagnosis of 46 years (17-64 years) and 53 (69.7%) were male. This population included several types of aNHL particularly Diffuse large B-cell lymphoma (DLBCL) n=46 (60.5%), High grade B- cell lymphomas, NOS n = 3 (3.9%), Mantle cell lymphoma (MCL) n = 22 (28.9%) and T-cell lymphomas n = 5 (6.6%). Patients were treated with a median of 2 therapeutic lines (range 1-4) and had a ECOG ≤1, prior to ASCT. The response assessments after day 100, was statistically significant (p<0.001) favoured the transplant, from the 17 patients with PR prior to ASCT, 12 achieved CR.
With a median follow-up of 74 months, we observed no statistically significant difference in the median overall survival (OS) of the entire study population, however, in subgroup analysis by lymphoma subtype there was a significant difference in the OS of patients with DLBCL (PR vs CR: 106m vs NR; p =0.003).
Twenty patients relapsed after ASCT, the median time until relapse was 46 months. Progression-free survival (PFS) of the entire cohort, defined from the time of ASCT to the time of relapse, revealed lower time to relapse in patients with PR prior to ASCT compared to patients in CR (86 months vs 135 months; p = 0.01).
Conclusion
Patients with DLBCL transplanted in PR after high dose chemotherapy, had a lower overall survival compared to the CR group. This suboptimal prognosis raises the issue whether chemotherapy should be optimized prior to consolidation with ASCT.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous stem cell collection, Non-Hodgkin's lymphoma, Relapsed lymphoma