1 / 22

Autologous Stem Cell Transplantation for the Treatment of Follicular NHL

Case Presentation. 40 yo woman with no significant PMH presented with LUQ abdominal pain, 50 lb weight loss, and night sweats. On physical exam, she was found to have massive splenomegaly and peripheral lymphadenopathy. CT? adenopathy in axilla (2-3 cm), RP (7.5 x 5 cm), and inguinal (2-3 cm); spleen 22 cm.Inguinal LN biopsy? grade I follicular NHLBone marrow biopsy? 70% cellularity with 30-50% involvement with follicular NHLFLIPI score 4 (Hgb 11.6, LDH 356, Stage IV, > 4 nodal areas)5 yr9441

Albert_Lan
Download Presentation

Autologous Stem Cell Transplantation for the Treatment of Follicular NHL

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Autologous Stem Cell Transplantation for the Treatment of Follicular NHL Amanda F. Cashen, M.D.

    3. Case Presentation R-CHOP x 6 cycles? PR 3 months after completion of R-CHOP, new cervical LAD found on physical exam; CT confirms “significant interval worsening” of adenopathy R-ESHAP x 3 cycles? PR, bone marrow (-) BEAM/auto? continued improvement in adenopathy

    4. Treatment of Relapsed Follicular Lymphoma Repeat standard first-line therapy Rituxan (27-69% RR) Labelled Ab ([I131] tositumomab has RR 83% and PFS 12 mo) Autologous SCT Allogeneic SCT

    6. Auto stem cell transplant for follicular NHL Patients who have responded to chemotherapy have similar survival whether transplanted in first or subsequent remissions Little or no benefit for chemoresistant patients ASCT prolongs remission but pts continue to relapse over time Purging the bone marrow of malignant cells may reduce relapse

    7. Long-term Follow-up of Autologous Bone Marrow Transplantation in Patients with Relapsed Follicular Lymphoma Blood 1999; 10: 3325-3333 153 pts with relapsed follicular NHL Conditioning with cyclophosphamide/TBI; BM purged of B-cells DFS 42% and OS 66% at 8 yrs, 12 yr survival 69% One treatment related death, 18 second malignancies (12 MDS) 63 patients relapsed, usually in sites of prior disease From Dana FarberFrom Dana Farber

    8. RIT conditioning regimens Both from Seattle. Second study was cohort analysisBoth from Seattle. Second study was cohort analysis

    9. ASCT in first remission 3 trials randomized patients to ASCT or interferon maintenance after induction with CHOP

    10. High-Dose Therapy Improves Progression-Free Survival and Survival in Relapsed Follicular Non-Hodgkin’s Lymphoma: Results from the Randomized European CUP Trial JCO 2003; 21 Designed to answer two questions: Is high dose chemotherapy/auto SCT more effective than standard treatment? Does purging of the stem cell graft impact outcome? Study Population Relapsed or progressive follicular NHL Age 15-65

    11. Trial Design

    12. Patient Characteristics

    13. Results Only sample size needed for C vs. P comparison was achieved. 89 patients were randomly assigned to treatment—70 assigned to C, U, or P; 19 assigned to U or P Patient characteristics were balanced across groups Compliance with assigned treatment not great Median follow-up 69 months

    14. Overall and Progression-free Survival

    16. Conclusions In patients with relapsed follicular NHL, high-dose chemotherapy followed by autologous stem-cell transplantation translates into improved progression-free survival and overall survival. These data do not provide evidence that purging of the stem-cell graft improves outcome. Too few patients in the study? Too many centers performing the purging? Purging isn’t effective?

    17. Myeloablative therapy with autologous BMT for follicular lymphoma at the time of second or subsequent remission JCO 2007;25:2554 121 pts with follicular NHL in 2nd (36%) or subsequent (64%), complete (58%) or partial (12%) remission treated with cytoxan/TBI/auto BMT from 1985-1992 55% 5-yr DFS 48% 10 yr DFS DFS did not correlate with: quality of remission prior to transplant number of remission bone marrow status number of previous treatments time from diagnosis At minimum f/u of 9 years: 57 pts are alive 20 pts died without progression 37 pts died as a result of recurrent lymphoma 27 pts died from other causes British hospital and Dana FarberBritish hospital and Dana Farber

    20. A 15 yr analysis of early and late autologous SCT in relapsed, aggressive follicular lymphoma BB&MT 2007;13:956 Single center, OttawaSingle center, Ottawa

    22. Conclusions Autologous SCT can provide long-term DFS (cure?) for patients with chemosensitive relapsed follicular NHL The rate of secondary MDS/AML is significant Related to prior therapy? Better if non-TBI containing conditioning regimens are used? Should autologous SCT be considered for most patients with relapsed follicular NHL? How do the results with auto SCT compare to rituximab-based chemo regimens?

More Related