Contributions
Abstract: EP507
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The prognosis of patients who relapsed after hematopoietic stem cell transplantation (HSCT) is generally poor. However, the survival post-progression (SPP) after HSCT in lymphoma patients has not been well evaluated.
Aims
The aim of this study is to evaluate and identify the prognostic factors for SPP.
Methods
Using the Japanese transplant registry, adult patients (> 15 years old) who underwent their first autologous (auto-HSCT) or allogeneic HSCT (allo-HSCT) for lymphoma in 1980–2018 were analyzed. SPP was defined as the time from progression or relapse after HSCT to death. To identify the prognostic factors for SPP, univariate and multivariate analyses were conducted. This study was approved by the Japan Society for Hematopoietic Cell Transplantation Ethical Committee.
Results
A total of 15,097 transplant cases, including 10,973 and 4,124 after auto-HSCT and allo-HSCT, respectively, were analyzed. In patients who underwent auto-HSCT, the major primary disease included diffuse large B-cell lymphoma (DLBCL) in 5,803 patients, Hodgkin lymphoma (HL) in 1,261, follicular lymphoma (FL) in 1,139, mantle cell lymphoma (MCL) in 659. In patients who underwent allo-HSCT, the primary disease included DLBCL in 1,201 patients, FL in 894, peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) in 448, extranodal NK/T-cell lymphoma (ENKTL) in 334. Enteropathy associated T-cell lymphoma (EATL) patients had the highest relapse rate among patients after auto- and allo-HSCT (62% and 75%, respectively). Among patients after auto-HSCT, the median SPP was poor in patients with BL (3.1 months) and EATL (5.8 months). In contrast, the 2-year SPP was more than 60% in patients with HL, FL, MCL, and subcutaneous panniculitis like-T-cell lymphoma (SPTCL). In the univariate and multivariate analyses, patients’ age, disease status at HSCT, HSCT year, time from HSCT to relapse or progression, subsequent HSCT, and lymphoma subtype were identified as risk factors. Chemo-resistant or relapsed disease was a risk factor for worse SPP [hazard ratio (HR) 1.5 (95% confidence interval (CI) 1.3-1.6), vs complete response (CR)]. Early relapse or progression [within 3 months (HR 3.0, 95% CI 2.7-3.3) and 6 months (HR 1.7, 95% CI 1.5-1.9) vs more than 1 year] was also significant prognostic factor. All lymphoma subtypes, except for MCL and SPTCL, were significantly associated with worse SPP compared with FL. Subsequent HSCT was associated with better SPP (HR 0.8, 95% CI 0.7-0.9). In the subgroup analyses by lymphoma subtypes, subsequent HSCT improved SPP in patients with HL, DLBCL, and most T-cell lymphomas. Among patients after allo-HSCT, the median SPP was shortest in patients with Burkitt lymphoma (BL) and aggressive NK-cell leukemia (ANKL) (both, 1.9 months), whereas it was longest in HL patients (13.6 months). In the univariate and multivariate analyses, age, disease status, time from HSCT to relapse or progression, and lymphoma subtype were identified as risk factors. Chemo-resistant disease was a prognostic factor for SPP (HR 2.0, 95%CI, 1.6-2.4). Majority of lymphoma subtypes, except for several subtypes including FL, MCL and ENTKL, were significantly associated with worse SPP compared with HL. The strongest association with poor SPP was observed in BL (HR 2.4, 95%CI 1.7-3.5) and ANKL (HR 3.3, 95%CI 2.1-5.1).
Conclusion
The lymphoma subtype, as well as age and disease status, were identified as risk factors. Subsequent HSCT after auto-HSCT play an important role in improving SPP in several lymphoma subtypes. For patients with poor SPP, an improvement of subsequent treatment strategy is warranted.
Keyword(s): Lymphoma, Relapse, Stem cell transplant, Survival prediction
Abstract: EP507
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The prognosis of patients who relapsed after hematopoietic stem cell transplantation (HSCT) is generally poor. However, the survival post-progression (SPP) after HSCT in lymphoma patients has not been well evaluated.
Aims
The aim of this study is to evaluate and identify the prognostic factors for SPP.
Methods
Using the Japanese transplant registry, adult patients (> 15 years old) who underwent their first autologous (auto-HSCT) or allogeneic HSCT (allo-HSCT) for lymphoma in 1980–2018 were analyzed. SPP was defined as the time from progression or relapse after HSCT to death. To identify the prognostic factors for SPP, univariate and multivariate analyses were conducted. This study was approved by the Japan Society for Hematopoietic Cell Transplantation Ethical Committee.
Results
A total of 15,097 transplant cases, including 10,973 and 4,124 after auto-HSCT and allo-HSCT, respectively, were analyzed. In patients who underwent auto-HSCT, the major primary disease included diffuse large B-cell lymphoma (DLBCL) in 5,803 patients, Hodgkin lymphoma (HL) in 1,261, follicular lymphoma (FL) in 1,139, mantle cell lymphoma (MCL) in 659. In patients who underwent allo-HSCT, the primary disease included DLBCL in 1,201 patients, FL in 894, peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) in 448, extranodal NK/T-cell lymphoma (ENKTL) in 334. Enteropathy associated T-cell lymphoma (EATL) patients had the highest relapse rate among patients after auto- and allo-HSCT (62% and 75%, respectively). Among patients after auto-HSCT, the median SPP was poor in patients with BL (3.1 months) and EATL (5.8 months). In contrast, the 2-year SPP was more than 60% in patients with HL, FL, MCL, and subcutaneous panniculitis like-T-cell lymphoma (SPTCL). In the univariate and multivariate analyses, patients’ age, disease status at HSCT, HSCT year, time from HSCT to relapse or progression, subsequent HSCT, and lymphoma subtype were identified as risk factors. Chemo-resistant or relapsed disease was a risk factor for worse SPP [hazard ratio (HR) 1.5 (95% confidence interval (CI) 1.3-1.6), vs complete response (CR)]. Early relapse or progression [within 3 months (HR 3.0, 95% CI 2.7-3.3) and 6 months (HR 1.7, 95% CI 1.5-1.9) vs more than 1 year] was also significant prognostic factor. All lymphoma subtypes, except for MCL and SPTCL, were significantly associated with worse SPP compared with FL. Subsequent HSCT was associated with better SPP (HR 0.8, 95% CI 0.7-0.9). In the subgroup analyses by lymphoma subtypes, subsequent HSCT improved SPP in patients with HL, DLBCL, and most T-cell lymphomas. Among patients after allo-HSCT, the median SPP was shortest in patients with Burkitt lymphoma (BL) and aggressive NK-cell leukemia (ANKL) (both, 1.9 months), whereas it was longest in HL patients (13.6 months). In the univariate and multivariate analyses, age, disease status, time from HSCT to relapse or progression, and lymphoma subtype were identified as risk factors. Chemo-resistant disease was a prognostic factor for SPP (HR 2.0, 95%CI, 1.6-2.4). Majority of lymphoma subtypes, except for several subtypes including FL, MCL and ENTKL, were significantly associated with worse SPP compared with HL. The strongest association with poor SPP was observed in BL (HR 2.4, 95%CI 1.7-3.5) and ANKL (HR 3.3, 95%CI 2.1-5.1).
Conclusion
The lymphoma subtype, as well as age and disease status, were identified as risk factors. Subsequent HSCT after auto-HSCT play an important role in improving SPP in several lymphoma subtypes. For patients with poor SPP, an improvement of subsequent treatment strategy is warranted.
Keyword(s): Lymphoma, Relapse, Stem cell transplant, Survival prediction