Outcome after high-dose therapy with autologous stem cell rescue with BEAM for relapsed follicular lymphoma.

Abstract

e18512 Background: The role of high-dose therapy with autologous stem cell rescue (HDT-ASCR) remains a major challenge in the management of patients (pts) with follicular lymphoma (FL), particularly in view of the undoubted clinical impact of rituximab and the advent of therapeutic options such as reduced intensity conditioning allotransplants. Cyclophosphamide/total body irradiation (Cy-TBI) is associated with a high incidence of secondary myelodysplasia/acute myeloid leukaemia (sMDS/AML) in heavily pretreated pts, but it is not known if the number of prior therapy lines also influences prognosis in pts treated with BEAM for relapsed FL. This is currently of special relevance to decide the best timing for this therapy as it is pts who did not receive 1st-line rituximab (R) that are presenting with recurrent FL. Methods: From 1997 to 2008, 80 pts (41M/39F; median age: 51 yrs, range: 31-67), including 30 with transformed FL (tFL), received HDT-ASCR with BEAM for relapsed FL at our center. Results: The median time from diagnosis to HDT was 41 months (range: 4-165). The median number of previous treatment lines was 3, 61% of the pts having received >3. Thirty-eight pts (49%) received R before HDT (as part of the 1st line therapy: 1; as part of the salvage therapy before BEAM: 28; as part of the HDT: 4). There was a trend for a higher use of R before BEAM in pts with FL (56%) in comparison with those with tFL (33%, p=0.05). After a median follow-up of 76 months (range: 14-160), 2 pts developed sMDS/AML. Five-year overall survival (OS) was 71% and progression-free survival (PFS) 44%. There were no differences in PFS or OS according to the number of previous treatment lines or episodes of disease. Likewise, histology at relapse did not impact on PFS or OS. Comparison with a historical control of pts treated with Cy-TBI showed no significant differences in PFS or OS. Conclusions: Deferring HDT with BEAM until 3rd response does not impair OS in pts with FL. 5-yr PFS (%) P value 5-yr OS (%) P value Histology FL (50) tFL (30) 43 45 0.5 75 63 0.1 Episodes 1-2 (58) >3 (22) 47 33 0.4 74 61 0.1 Treatment lines 1-2 (31) >3 (49) 49 41 0.5 79 65 0.1 Prior R Yes (38) No (42) 50 40 0.2 69 71 0.6 Conditioning regimen Cy-TBI (132) BEAM (80) 59 44 0.06 65 71 0.4