Post-autologous transplant maintenance therapies in lymphoid malignancies: are we there yet? Bone Marrow Transplant 2015 Nov;50(11):1393-404
Date
08/19/2015Pubmed ID
26281033DOI
10.1038/bmt.2015.184Scopus ID
2-s2.0-84947047644 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
Disease relapse after autologous hematopoietic transplant (auto-HCT) remains the number one cause of post-transplant therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at the prevention of post-auto-HCT therapy failure with various maintenance strategies. The benefit of such therapies is in turn dependent on disease histology and timing of transplantation. Although high dose therapy (HDT) provides durable responses in chemosensitive relapsed diffuse large B-cell lymphoma (DLBCL), a sizable subset experiences disease relapse. Unfortunately, the addition of rituximab as a post-auto-HCT maintenance strategy did not improve survival outcomes. The preliminary results with programmed death -1 (PD-1) Ab as post-auto maintenance in DLBCL is promising but requires randomized validation. In follicular lymphoma, the 5- and 10-year PFS rates are ~60% and 31%, respectively. Although the addition of rituximab improved PFS, there is no survival benefit, to date. Disease relapse after auto-HCT in mantle cell lymphoma (MCL) is not uncommon. Rituximab maintenance in this setting provides a PFS benefit. Given the poor prognosis of post-auto-HCT failures in MCL, maintenance can be considered on a case-by-case basis. In chemosensitive relapsed Hodgkin lymphoma, addition of brentuximab vedotin after auto-HCT improved 2-year PFS (65 vs 45%) and can be considered as an option for maintenance therapy post auto-HCT, in select higher risk patients. Ongoing trials evaluating the efficacy of post-auto-HCT maintenance with novel agents (for example, immunomodulators, proteasome inhibitors, PD-1 inhibitors, Bruton's tyrosine kinase inhibitors and so on) will likely change the practice landscape for lymphoma patients following HDT and auto-HCT.
Author List
Epperla N, Fenske TS, Lazarus HM, Hamadani MAuthors
Timothy Fenske MD Professor in the Medicine department at Medical College of WisconsinMehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Antibodies, MonoclonalAntineoplastic Combined Chemotherapy Protocols
Clinical Trials as Topic
Combined Modality Therapy
Disease-Free Survival
Forecasting
Genes, cdc
Hematopoietic Stem Cell Transplantation
Histone Deacetylase Inhibitors
Humans
Immunotherapy
Immunotoxins
Lymphoma
Maintenance Chemotherapy
Molecular Targeted Therapy
Neoplasm Proteins
Programmed Cell Death 1 Receptor
Protein Kinase Inhibitors
Protein-Tyrosine Kinases
Randomized Controlled Trials as Topic
Rituximab
Signal Transduction
Survival Rate
Transplantation, Autologous
Treatment Outcome