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.
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.
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.
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).
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).
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.
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.
- 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