No Benefit With Upfront Rituximab and Autologous HSCT Consolidation for Aggressive Non-Hodgkin Lymphomas

A recent meta-analysis suggested that for patients with aggressive non-Hodgkin lymphomas (NHLs), upfront autologous hematopoietic stem cell transplantation (autoHCT) consolidation may not provide a clinical benefit compared with upfront treatment using rituximab and chemotherapy. Results of the meta-analysis were published in Cancer.

The meta-analysis was based on a literature review, with references identified from a search of Cochrane and PubMed/MEDLINE databases that was performed on December 1, 2018. Inclusion criteria for this analysis involved reporting on adult patients with diffuse large B-cell lymphoma (DLBCL) in addition to a comparison of rituximab plus chemotherapy (R-chemo) with R-chemo plus autoHCT within a randomized, controlled trial.

The meta-analysis incorporated data from 4 studies (1173 patients), with median follow-up times varying from 42 to 76 months. The majority of patients had DLBCL, but other B-cell NHLs and T-cell NHL were also included.

The researchers found no statistical difference in overall survival (OS) for R-chemo plus autoHCT compared with R-chemo alone (hazard ratio [HR], 1.01; 95% CI, 0.74-1.37; P =.96). In an analysis that included only patients with high-risk age-adjusted International Prognostic Index (aaIPI) scores, there also was no statistical difference in OS by treatment (HR, 0.75; 95% CI, 0.47-1.19; P =.22).

Progression-free survival (PFS) times were not significantly different for R-chemo plus autoHCT compared with R-chemo alone (HR, 0.77; 95% CI, 0.58-1.04; P =.09), including when high-risk aaIPI status was considered (HR, 0.51, 95% CI, 0.23-1.10; P =.09).

R-chemo plus autoHCT showed significantly higher rates of adverse events of grade 3 or 4 for infections, gastrointestinal adverse events, and hematologic adverse events. Grade 3 or 4 cardiac and neurologic adverse events showed similar frequencies between treatments.

“To the best of our knowledge, the current study is the first meta-analysis in the rituximab era to demonstrate no beneficial effect of upfront auto-HCT consolidation in patients with aggressive B-cell NHL, including those patients in the high-risk clinical groups (high aaIPI),” wrote the authors.

Reference

1. Epperla N, Hamadani M, Reljic T, Kharfan-Dabaja MA, Savani BN, Kumar A. Upfront autologous hematopoietic stem cell transplantation consolidation for patients with aggressive B-cell lymphomas in first remission in the rituximab era: a systematic review and meta-analysis [published online August 23, 2019]. Cancer. doi:10.1002/cncr.32464

This article originally appeared on Hematology Advisor