The International Prognostic Index predicts for outcome following autologous stem cell transplantation in patients with relapsed and primary refractory intermediate-grade lymphoma

Purpose To study the outcome of histologic transformation (HT) in a large prospective cohort of patients with follicular lymphoma (FL) who previously responded to immunochemotherapy. Patients and Methods After a median 6-year follow-up of 1,018 randomly assigned patients from the PRIMA trial, disease progression was observed in 463 patients, 194 of whom had histologic documentation. Results Forty patients had histology consistent with HT, and 154 had untransformed FL (median time to recurrence, 9.6 v 22.8 months, respectively; P = .018). Thirty-seven percent of biopsies performed during the first year of follow-up showed HT corresponding to 58% of all HTs. Altered performance status, anemia, high lactate dehydrogenase level, “B” symptoms, histologic grade 3a, and high Follicular Lymphoma International Prognostic Index scores at diagnosis were identified as HT risk factors. Response (complete v partial) to immunochemotherapy or rituximab maintenance had no impact on the risk of HT. After salvage treatment, patients with HT had less frequent complete response (50.3% v 67.4%; P = .03) and more disease progression (28.2% v 9.6%; P < .001) than patients without HT. Estimated overall survival for the patients with HT was poorer (median, 3.8 v 6.4 years; hazard ratio, 3.9; 95% CI, 2.2 to 6.9). Autologous stem cell transplantation improved the outcomes of patients with HT (median overall survival, not reached v 1.7 years) but not of patients with persistent FL histology. Conclusion HT in patients with FL who previously responded to immunochemotherapy is an early event associated with a poor outcome that may deserve intensive salvage with autologous stem cell transplantation. These data emphasize the necessity for biopsy at the first recurrence of FL.

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Long-Term Outcomes of Autologous Stem Cell Transplantation for Follicular Non-Hodgkin Lymphoma: Effect of Histological Grade and Follicular International Prognostic Index

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2007.06.016 ◽

2008 ◽

Vol 14 (1) ◽

pp. 36-42 ◽

Cited By ~ 57

Author(s):

Julie M. Vose ◽

Philip J. Bierman ◽

Fausto R. Loberiza ◽

James C. Lynch ◽

Gregory R. Bociek ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Hodgkin Lymphoma ◽

Autologous Stem Cell Transplantation ◽

Histological Grade ◽

International Prognostic Index ◽

Prognostic Index ◽

Long Term Outcomes ◽

Non Hodgkin Lymphoma

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Central Nervous System (CNS) Relapse In a Population of 143 Patients (Pts) with Mantle Cell Lymphoma (MCL) From Two Centers

Blood ◽

10.1182/blood.v118.21.2660.2660 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2660-2660

Author(s):

Annarita Conconi ◽

Silvia Franceschetti ◽

Chiara Lobetti-Bodoni ◽

Anastasios Stathis ◽

Riccardo Bruna ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Univariate Analysis ◽

International Prognostic Index ◽

Intrathecal Chemotherapy ◽

High Dose ◽

Cns Disease ◽

Cns Relapse

Abstract Abstract 2660 Inconsistent information concerning the pattern of CNS relapse have been reported in MCL pts. We retrospectively analyzed the clinical variables at diagnosis and outcome, with special reference to CNS relapse, in a population of consecutive pts with confirmed diagnosis of MCL from two hematology centers. Among 2426 non Hodgkin's lymphoma pts treated from 1979 to 2011, 142 cases (44 female, 98 male) of MCL were selected. Median age at diagnosis was 68 years (17–94 years); 116 pts (82%) had stage III-IV, 89 (67% of the 132 cases in whom the data was available) had intermediate-high/high International Prognostic Index (IPI) risk. Extranodal disease was reported in 127 pts (89%), serum LDH was elevated in 45 pts (40% of 113 tested pts). Information concerning first line treatment was available in 139 pts. Fourteen pts (10%) did not receive active treatment at diagnosis, in 7 (5%) of these, systemic treatment followed the initial expectant strategy. Four pts (3%) only received radiotherapy and/or surgery. One hundred twenty two pts (88%) were treated with chemotherapy, 46 pts (33%) had rituximab, alone (6 pts, 4%) or in combination with chemotherapy. Eighteen pts (13%) received chemotherapy regimens including drugs crossing the blood-brain barrier or prophylactic intrathecal chemotherapy, 10 pts (7%) had autologous stem cell transplantation. After median follow-up of 8 years, CNS relapse was observed in 11 cases (7.7%; 95%CI:4–13%). CNS disease occurred at a median of 13.8 months (range:3.7–95 months) from diagnosis. Cumulative risk of CNS relapse raises until 10 years, being 7.2% (95%CI:4–14%) at 3 years, 10.6% (95%CI:6–19%) at 5 years and 13.6% (95%CI:7–25%) at 10 years. Elevated serum LDH at diagnosis was significantly associated with higher risk of CNS relapse at univariate analysis (P=0.006). Actuarial risk of CNS relapse was significantly shorter in pts with higher risk according to IPI (P=0.018). Median survival after CNS relapse was 6.3 months (range: 1.5–77 months). CNS relapse had a dismal impact on survival (P=0.04). No specific treatment approach at diagnosis, including autologous stem cell transplantation, intrathecal chemotherapy, high dose cytarabine or rituximab, alone or in combination with chemotherapy, significantly reduced the risk of CNS relapse. CNS relapse is one of the most challenging events in the management of MCL. Our data confirmed the adverse clinical outcome of MCL after CNS relapse. Better definition of clinico-pathological profile at diagnosis suggesting higher risk of CNS relapse could select pts candidate to prophylactic approach addressed to prevent CNS disease. Disclosures: No relevant conflicts of interest to declare.

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