Excellent outcomes of transformed lymphomas in the rituximab era without autologous stem cell transplantation: an Australian single-centre experience.

Abstract

BACKGROUND:

Histologic transformation (HT) is an important event with adverse prognosis in the natural history of indolent lymphomas. There are minimal data on HT in the Australian setting.

AIMS:

To characterise patients with biopsy-proven HT and their outcomes identified at a tertiary Australian Hospital.

METHODS:

All patients with biopsy-proven HT during a 15-year period (2002-2017) were included. Clinico-pathological data were systematically collected from review of patient records. Survival estimates were assessed using the Kaplan-Meier method and compared using the log-rank test. Associations between variables and clinical outcomes were evaluated using Cox's proportional hazards model.

RESULTS:

A cohort of 45 patients was identified with a median age of 66 years and the majority (59%) having high-risk disease (Revised-International Prognostic Index score ≥3). R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) induction was used in 69%, with an overall response rate of 82% (complete response (CR), 75%). Sixty-one percent of these induction responders received consolidation, with autologous stem cell transplant (ASCT) performed in only 17% and rituximab maintenance given to 31%. With a median follow up of 47 months (range: 4-136), the 5-year overall survival (OS) was 69% (95% CI: 52%, 81%). Chemotherapy-naivety at HT was associated with a superior rate of CR (84% vs 54%, P = 0.057) and 5-year OS (82% vs 46%, P = 0.012). Rituximab maintenance was associated with a durable progression-free survival in induction responders.

CONCLUSIONS:

Excellent OS was observed in this modern cohort of patients treated with rituximab-containing induction and low rate of consolidation by ASCT, particularly in those who were chemotherapy-naïve at HT.

• Authors: Aditya Tedjaseputra, Michael Gilbertson, Michael Low, Pasquale L Fedele, Beena Kumar, Ian Simpson, George Grigoriadis, Jake Shortt, Stephen Opat, Gareth P Gregory
• Journal: Internal medicine journal (Intern Med J) Vol. 51 Issue 11 Pg. 1825-1834 (Nov 2021) ISSN: 1445-5994 [Electronic] Australia
• PMID: 32609419 (Publication Type: Journal Article)
• Copyright: © 2020 Royal Australasian College of Physicians.

Chemical References

• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Australia (epidemiology)
• Cyclophosphamide
• Disease-Free Survival
• Doxorubicin
• Hematopoietic Stem Cell Transplantation
• Humans
• Lymphoma, Non-Hodgkin
• Neoplasm Recurrence, Local
• Prednisone
• Rituximab
• Transplantation, Autologous
• Vincristine