Impact of positron emission tomography - computed tomography status on progression-free survival for relapsed follicular lymphoma patients undergoing autologous stem cell transplantation
Toby A. Eyre,
Sally F. Barrington,
Jessica Okosun,
Clementina Abamba,
Rachel M. Pearce,
Julia Lee,
Ben Carpenter,
Charles R. Crawley,
Adrian J.C. Bloor,
Maria Gilleece,
Emma Nicholson,
Nimish Shah,
Kim Orchard,
Ram Malladi,
William M. Townsend
Affiliations
Toby A. Eyre
Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
Sally F. Barrington
King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London
Jessica Okosun
Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
Clementina Abamba
BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
Rachel M. Pearce
BSBMTCT data registry, 5th Floor Tabard House, Talbot Yard, Guy's Hospital, Great Maze Pond, London
Julia Lee
Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London
Ben Carpenter
Department of Haematology, University College London Hospitals 235 Euston Road, London
Charles R. Crawley
Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
Adrian J.C. Bloor
Department of Haematology, The Christie Hospital NHS Trust, Manchester
Maria Gilleece
Department of Haematology and Bone Marrow Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds
Emma Nicholson
Department of Haematology and Bone Marrow Transplantation, Royal Marsden Hospital, London
Nimish Shah
Department of Haematology, Norfolk and Norwich University Hospitals, Norwich
Kim Orchard
Department of Haematology and Bone Marrow Transplantation, Southampton University Hospitals, Southampton
Ram Malladi
Department of Haematology and Bone Marrow Transplantation, Addenbrookes Hospital, Cambridge
William M. Townsend
Department of Haematology, University College London Hospitals 235 Euston Road, London
The optimum management approach for patients with relapsed or refractory follicular lymphoma remains uncertain. Autologous stem cell transplantation (autoSCT) is considered a standard option in suitable, younger patients with relapsed follicular lymphoma. AutoSCT is associated with very durable remissions in a minority of subjects, but also with significant, well-established toxicities. Although positron emission tomography (PET) status prior to autoSCT is an established prognostic factor in diffuse large B-cell lymphoma and Hodgkin lymphoma, no data exist in follicular lymphoma. We describe survival outcomes according to pre-transplant PET status, classified by the Lugano criteria into complete metabolic remission (CMR) versus non-CMR, in 172 patients with relapsed or refractory follicular lymphoma within a national, multicenter, retrospective British Society of Blood and Marrow Transplantation and Cellular Therapy registry study. The median number of lines of therapy prior to SCT was three (range, 1-6). The median follow-up after SCT was 27 months (range, 3–70). The median progression-free survival for all patients after autoSCT was 28 months (interquartile range, 23- 36). There was no interaction between age at transplantation, sex, number of months since last relapse, Karnofsky performance status or comorbidity index and achieving CMR prior to autoSCT. Superior progression-free survival was observed in 115 (67%) patients obtaining CMR versus 57 (33%) non-CMR patients (3-year progression-free survival 50% vs. 22%, P=0.011) and by pre-SCT Deauville score (continuous variable 1-5, hazard ratio [HR]=1.32, P=0.049). PET status was independently associated with progression-free status (non-CMR HR=2.02, P=0.003), overall survival (non-CMR HR=3.08, P=0.010) and risk of relapse (non-CMR HR=1.64, P=0.046) after autoSCT by multivariable analysis. Our data suggest that pre- SCT PET status is of clear prognostic value and may help to improve the selection of patients for autoSCT.
