Stem Cell Transplant Outcomes for Follicular Lymphoma, A Key Benchmark for New Therapies

Follicular lymphoma (FL) is a type of non-Hodgkin lymphoma, which can have more than one relapse despite the use of chemo-immunotherapy. Some patients with a more aggressive follicular lymphoma can often face therapy limitations, with hematopoietic stem cell transplantation (HSCT) being the only potentially curative option. 

At the 66th annual ASH conference, Dr. Yasmina Serroukh, lead investigator and presenter of the study we’ll cover in this article, shared insights of her research with the HealthTree press.  

Analyzing Twelve Years of Data

Researchers analyzed data from the European Society for Blood and Marrow Transplantation (EBMT) registry, covering adult follicular lymphoma patients who underwent their first hematopoietic stem cell transplant between 2010 and 2022. 

A total of 7,330 ASCT patients were included, and the analysis reported the following key findings:

• The median age was 57 years, with 58% being male. Most patients (86%) had prior exposure to rituximab.
• Disease Status at Transplant: 53% of patients were in complete response (CR), 37% in partial response (PR), and 10% had refractory disease.
• Conditioning Regimen: The BEAM regimen  (BCNU, etoposide [ETP], Ara‐C, and melphalan) was used to treat the follicular lymphoma in 66% of cases, and 99% received peripheral blood stem cells (PBSC).

Survival Outcomes

The three-year overall survival showed 81%, progression-free survival (PFS), 55%, relapse incidence (RI) was 41%, and non-relapse mortality (NRM) was 5%. After 10-years, the overall survival (OS) was 58%, and PFS was 37%.

Outcomes of Allogeneic Stem Cell Transplantation (Allo-HSCT)

Allogeneic stem cell transplantation is the  procedure in which a patient receives healthy blood-forming cells from a donor, this has the advantage of more availability to proceed with the transplant opposed to autologous-HSCT (the process that uses the same patient’s stem cells) since it doesn’t require a long preparation before receiving the transplant. But it also comes with some cons as it could have the risk of graft versus host disease (GVHD).    

The analysis included 1,901 allo-HSCT patients. Findings highlight:

• Demographics: The median age was 54 years, with 62% being male. Approximately 53% had relapsed after a prior ASCT.
• Disease Status at Transplant: At transplant, 48% were in CR, 32% in PR, and 20% had stable or progressive disease (SD-PD).
• Conditioning Regimen: Reduced-intensity conditioning (RIC) was used in 72% of cases, with total body irradiation (TBI) included in 23%. PBSCs were the predominant cell source (93%).
• Donor Sources: Matched unrelated donors (MUD) accounted for 57%, siblings for 34%, and haploidentical donors for 8%.
• Survival Outcomes:
  • At 5 years, the overall survival was 59%, PFS was 51%, RI was 20%, and NRM was 30%.
  • At 10 years: OS was 51%, PFS was 44%, and GVHD-free, relapse-free survival (GFRFS) was 29%.
• Graft-Versus-Host Disease (GVHD):
  • Acute GVHD incidence at day 100: 30% for grade 2-4 and 12% for grade 3-4.
  • Chronic GVHD incidence at 2 years: 17%.

What Influences the Outcomes of Allo-HSCT? 

Multivariate analysis revealed several predictors of survival and outcomes:

• Age: Older age was associated with worse overall survival in both reduced-intensity conditioning (RIC) and myeloablative conditioning (MAC) recipients.
• Disease Status: Patients in partial remission, stable or progressive disease had worse outcomes than those in complete remission, particularly in MAC recipients.
• Conditioning Regimen: total body irradiation-based conditioning improved the overall survival in those who received a reduced-intensity conditioning.
• Donor Type: Outcomes were better with matched sibling donors than with matched unrelated donors or haploidentical donors.

Implications for Patients and Caregivers

The findings underscore that both auto and allo-HSCT offer durable disease control for follicular lymphoma patients, serving as crucial benchmarks for emerging therapies. 

If you are interested in a stem cell transplant as part of your treatment regimen, talk to your physician to see if you qualify. 

Understanding these outcomes empowers patients and caregivers to make informed decisions about treatment options.

Final Thoughts

Stem cell transplants, both auto and allo, remain a pillar for follicular lymphoma in specific cases, with data supporting their role in achieving long-term remission. 

As the landscape of follicular lymphoma treatment evolves, these results provide a baseline for evaluating newer therapies and promoting informed self-advocacy among patients and caregivers.

If you want to keep learning more about follicular lymphoma through comprehensive results from the latest studies and conferences, you can bookmark the HealthTree News landing page, where you can browse different articles and topics written just for you! 

Keep Reading More Articles

Source:

• 749 Outcome of Hematopoietic Stem Cell Transplantation for Follicular Lymphoma, a Benchmark Study from the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation