Transplants Right After Induction Therapy not Convincing in Aggressive Disease

A new study shows that tackling aggressive lymphomas with stem cell transplants earlier rather than later doesn’t improve overall survival.

The study, published in the the New England Journal of Medicine and led by Patrick Stiff, M.D., director of Loyola University Medical Center’s Cardinal Bernardin Cancer Center, was designed to determine whether an early transplant would boost survival if done without first waiting for relapse. It included 397 patients with aggressive non-Hodgkin's lymphoma defined as being either at a high risk or intermediate high risk of relapsing following induction therapy.

The study

A total of 125 patients were randomly assigned to receive an autologous stem cell transplant immediately following R-CHOP, while 128 patients received three additional cycles of R-CHOP.

After a two-year follow-up, the percentage of patients who showed no disease progression were:

• Transplant group: 69 percent
• Control group: 55 percent

While the two-year survival rates were:

• Transplant group: 74 percent
• Control group: 71 percent

The first difference is considered statistically significant, but the second is not.

Further analysis of the data demonstrated a survival benefit for high-risk patients who had the transplant (two-year survival rate, 82 percent) compared to high-risk patients who did not have the transplant (64 percent).

"Early transplantation and late transplantation achieve roughly equivalent overall survival in the combined risk groups," wrote Stiff et al. "[But] early transplantation appears to be beneficial for the small group of patients presenting with high-risk disease."

Source: NEJM