Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment

Resumen:
Patients with follicular lymphoma (FL) who experience early therapy failure (ETF) within 2years of frontline immunochemotherapy have poor overall survival (OS). We analyzed the Grupo Espanol de Linfomas y Trasplantes de Medula sea registry to determine whether autologous stem cell transplantation (ASCT) is effective in this high-risk subgroup. Patients with non-transformed FL treated with rituximab were included in the analysis. ETF was defined as relapse/progression within 2years of starting first-line therapy. We identified two groups: the ETF cohort (n=52; 38 transplanted in second complete response [CR2] and 14 transplanted in second partial response [PR2]), and the non-ETF cohort (patients receiving ASCT in either CR2 [n=14] or PR2 [n=2], but who did not experience ETF following first-line therapy). There were no differences in 5-year progression-free survival (PFS) (49% vs 60%, respectively, P=0.49) nor in 5-year OS (81% vs 83%, respectively, P=0.8) between the ETF and non-ETF cohorts. Moreover, in the subgroup of patients who presented an interval from first relapse after primary treatment to ASCT of <1year, there were neither differences in terms of PFS (49% vs 66%, respectively, P=0.44) nor in OS (86% vs 85%, respectively, P=0.9) between both cohorts. Patients in the ETF cohort transplanted in CR showed a plateau in the PFS curves beyond 7years of follow-up, at 50%. Patients presenting ETF after frontline therapy lack standard therapeutic options. ASCT may be a curat