Autologous Stem Cell Transplantation Is a Curative Treatment Modality for Relapsed or Refractory Follicular Lymphoma, and Both Recent Rituximab Exposure and Follicular Lymphoma International Prognostic Index (FLIPI) 0–1 Scores Predict Improved Outcome
Bibliographic record
Abstract
Abstract Abstract 687 Purpose: Available data from published studies are inconclusive regarding the curative potential of high dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) for follicular lymphoma (FL), however, these studies often include heavily pre-treated, multiply relapsed patients who may have indolent lymphoma histology other than FL, and typically do not report long term follow-up post-ASCT, particularly in the Rituximab era. Our objective was to evaluate long term outcomes and prognostic factors associated with the use of ASCT exclusively for FL patients (pts). Patients and Method: We conducted a retrospective analysis of the first 100 consecutive pts with relapsed or refractory follicular lymphoma treated with HDCT/ASCT from 1993–2008 in Calgary (1993-1999=20, 2000–2003=33, 2004–2008=47). Prognostic factors for event-free (EFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Funded indications for Rituximab in FL changed during the study period in Calgary as follows: 1) monotherapy for relapsed FL in 2000, 2) with induction chemotherapy (R-CVP) in 2004, and 3) maintenance therapy in 2007. Results: Patient characteristics at ASCT include: median age 51 years (yrs) (30-71), age >60 yrs (n=24), median time from diagnosis to ASCT 38 months (mo)(4-190), status relapsed (n=79) or refractory (n=21), CR1<1 yr (n=60), number prior failed chemotherapy regimens (1=62, 2=27, ≥3=11), prior radiotherapy (n=21), transformed disease (n=23), stage 3–4 (n=73), marrow involvement (n=31), elevated LDH (n=33), FLIPI 2–5 at ASCT (n=64), Rituximab with mobilization regimen (n=51), Rituximab with mobilization or within 6 mo prior to ASCT (n=68, including 0 pts (0%) ASCT 1993–1999, 20 pts (61%) ASCT 2000–2003, and 47 (100%) ASCT 2004–2008), conditioning with Melphalan TBI (n=40) or HDCT without TBI (n=60 [BEAM=19, Fludarabine/Busulfan=19, Melphalan=14, Zevalin® Melphalan=5, other=3]). With a median follow-up of 63 mo (16-178) post-ASCT, 38 patients have relapsed, 23 of whom died of relapsed lymphoma. Severe toxicity included 2 treatment-related deaths, and 4 deaths from secondary AML/MDS. EFS (including relapse or death from any cause) and OS at 5 yrs were 57% (95%CI 47–57) and 71% (60-80) respectively, and at 10 yrs are projected to be 55% (44-66) and 63% (49-74) respectively. EFS and OS curves start to plateau between 6–8 yrs post-ASCT as depicted in the attached figure. Each pt characteristic listed above was evaluated in univariate analysis as a potential predictor of EFS, but the only factors associated with improved EFS were: 1) ASCT 2000–2008 vs. 1993–1999 (62% vs. 40%, p=0.024, HR 0.398 [0.178-0.885]), 2) Rituximab <6 mo prior to ASCT (63% vs. 44%, p=0.012, HR 0.418 [0.211-0.828]), and 3) FLIPI score 0–1 vs. 2–5 at ASCT (65% vs. 48%, p=0.028, HR 0.499 [0.269-0.927]). FLIPI 0–1 at ASCT remained predictive of improved 5 yr EFS within the subgroup of 80 pts transplanted in 2000–2008 (75% vs. 58%, logrank p=0.051, Wilcoxon p=0.021, HR 0.461 [0.212-1.004]). There was a progressive increase in EFS following ASCT corresponding to change in Rituximab indication for FL in Calgary (5 yr EFS 40% for ASCT 1993–1999, 54% for ASCT 2000–2003, and 69% for ASCT 2004–2008 [logrank p=0.048]). Conclusions: Our data support the curative potential of HDCT/ASCT when used for selected FL patients who have failed 1–2 prior chemotherapy regimens. Improvement in EFS for patients treated since 2000 are likely related to the more frequent use of Rituximab within 6 months of ASCT, either with stem cell mobilization or preceding re-induction therapy. This may be related to improved “in vivo” purging of autografts, however, this hypothesis requires further study. Finally, the FLIPI prognostic score 0–1 at ASCT predicts particularly good outcomes. Disclosures: No relevant conflicts of interest to declare.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".