Autologous Transplantation Improves Survival Rates For Follicular Lymphoma Patients Who Relapse Within 2-Years Of Chemoimmunotherapy: A Multi-Centre Retrospective Analysis Of Consecutively Treated Patients In The Real World

Abstract Introduction: Although rituximab-based chemoimmunotherapy (RChemo) significantly improves overall survival (OS) for follicular lymphoma (FL), approximately 20% of patients experience initial time to progression (TTP1) of ≤2 years (early relapse) and relatively poor OS. We conducted a retrospective study to evaluate OS rates for patients with early relapse who were treated with or without high dose therapy and autologous stem cell transplantation (ASCT). Methods: A retrospective, multi-centre, study was conducted to identify all patients aged 18 to 70 years who were consecutively diagnosed in Alberta with grade 1 to 3a FL prior to 2011, and eventually received RChemo as their initial systemic therapy. Patient characteristics including Follicular Lymphoma International Prognostic Index (FLIPI) factors at RChemo, treatment details including Rituximab-maintenance (RMaintenance), TTP post-RChemo, frequency of transformation at relapse, and treatments after relapse were obtained. TTP and OS following RChemo and ASCT were evaluated in univariate and multivariate analyses. Results: Interrogation of the Alberta Cancer Registry identified 397 patients diagnosed with FL prior to 2011 who received RChemo. At a median follow-up of 92 months (3-179), 148 (37.3%) of the 397 patients relapsed from RChemo, including 82 (20.7%) with early relapse ≤2years and 66 (16.6%) with late relapse >2years. Table 1.0 lists characteristics of the 148 patients who relapsed after RChemo. Seventy-one (48.0%) patients underwent ASCT at relapse. Conditioning regimens included high dose melphalan (n=49, 69%, of whom 35 also received total body irradiation), BEAM (carmustine, etoposide, cytarabine, melphalan, n=21, 29.6%), and CBV (cyclophosphamide, BCNU, VP-16, n=1, 1.4%). In total, there were 29.1% (n=43) deaths following relapse, with majority of deaths due to FL (n=32, 74.4%). The projected 10-year OS following first RChemo was 93.8% in those with no relapse, 76.4% with late relapse, and 56.9% with early relapse (logrank p Conclusions: Our study strongly suggests that the use of ASCT for FL patients who relapse within 2 years of RChemo is associated with improved OS. Download : Download high-res image (179KB) Download : Download full-size image Disclosures Peters: Gilead: Honoraria; Janssen: Honoraria; Lundbeck: Honoraria; Roche: Honoraria; Abbvie: Honoraria. Stewart: Merck: Honoraria; Janssen: Honoraria; Abbvie: Honoraria; Gilead: Honoraria; Seattle Genetics: Honoraria; BMS: Honoraria; Roche: Honoraria; Amgen: Honoraria; Servier: Honoraria; Lundbeck: Honoraria.