ASH: Stem Cell Transplants for Transformed Follicular Lymphoma?

More from the ASH preview: "Is Stem Cell Transplantation for Transformed Follicular Lymphoma Required in the Rituximab Era?"

As most of us know, Follicular Lymphoma sometimes transforms from a slow-growing indolent disease into a more aggressive lymphoma (often Diffuse Large B Cell). This happens to about 3% of FL patients every year, and the prognosis isn't good.

However, researchers from Royal Marsden Hospital in London say that much of what we know about Transformed Follicular Lymphoma comes from the pre-Rituxan Era, and doesn't consider the full effects of Rituxan on the disease. For example, in evaluating Transformed FL, patients who have had Rituxan Maintenance are often excluded from clinical trials. So they want to know what role Rituxan might play in Transformed FL, and whether or not Stem Cell Transplants (an aggressive treatment for an aggressive disease) are really necessary.

The researchers did a retrospective study, looking at records from Follicular Lymphoma patients from the past (2003 to 2013) who had transformed. They found 56 patients who fit the criteria.

The median time from diagnosis to transformation was just over 5 years. Of the 56 patients, 4 received an autologous Stem Cell Transplant (where stem cells come from the patient) and 2 received an allogeneic transplant, where a matched donor provides the stem cells.  50 patients received chemotherapy + Rituxan. Of those patients, 38 received R-CHOP, 13 recieved a different cho + Rituxan, and 9 received Involved Field Radiation Therapy (IFRT). 8 received Rituxan Maintenance after their post-transformation treatment. (There's some overlap with those numbers involving the IFRT and R-M.)

As for how well they did after treatment, measured by Overall Survival (OS) and Progression-Free Survival (PFS):
The R + chemo patients had a 2 year OS of 84.5% and PFS of 70.9%, and 5 year OS of 58.7% and PFS of 49.3%.
The R-CHOP patients had a 2 year OS of 89% and PFS of 76%, and 5 year OS of 59.5% and PFS of 51.7%.

But the patients who had R-Maintenance after their post-transplant treatment? They had a 2 year OS and PFS of 100%.

The researchers' conclusion: even the R-CHOP numbers are better than the numbers reported for Stem Cell Transplants, but the R-Maintenance numbers are clearly superior. They call for a closer look at using Rituxan Maintenance after treatments for patients who have transformed.

They are also very clear that their numbers are very small -- only 8 patients, and only after 2 years (not 5, as with the other treatments). So while it's very hopeful, it is a very small sample.

Transformation is a fear for many of us (if not all of us), and it's good to know there is another option being considered -- a fairly easy one that we already know something about.