Autologous transplant for relapsed follicular lymphoma: impact of pre-transplant rituximab sensitivity

Abstract

Patients with rituximab-refractory follicular lymphoma (FL) have limited options. Before the rituximab era, autologous stem cell transplant (ASCT) was shown to improve outcomes in chemotherapy-sensitive, relapsed FL, but the impact of rituximab-sensitivity on these results is unknown. We analyzed 194 consecutive relapsed patients with FL who underwent ASCT at out center and categorized them as rituximab-sensitive (RS, n = 35), rituximab-refractory (RR, n = 65) or no rituximab (NoR, n = 94) if transplanted before rituximab was used. Progression-free survival at 3 years was 85% in RS and 35% in RR patients (p = 0.0004). Only rituximab-sensitivity was significant on multivariate analysis with improved overall survival (OS) (hazard ratio [HR] 0.24, p = 0.01) and progression-free survival (PFS) (HR 0.35, p = 0.006) in RS patients and increased relapse in RR patients (HR 2.11, p = 0.01). Pre-transplant rituximab-sensitivity is a strong independent predictor of post-transplant outcomes in relapsed FL, although one-third of RR patients achieved a PFS of over 3 years with ASCT.

Keywords::

• Follicular lymphoma
• autologous transplant
• rituximab-refractory

Acknowledgements

This study received funding from NIH PO1CA44991, the Mary A. Wright Memorial Research Fund and a donation from Frank and Betty Vandermeer. A.K.G. is a Scholar in Clinical Research of the Leukemia and Lymphoma Society. The authors also thank members of the research and clinical staff at the Seattle Cancer Care Alliance, and referring physicians for their contribution to the care of our patients.

Potential conflict of interest

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