Kristina Noring1,2, Mattias Carlsten2,3, Kristina Sonnevi1,2, Björn Engelbrekt Wahlin4,5. 1. Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. 2. Hematology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden. 3. Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden. 4. Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. bjorn.wahlin@sll.se. 5. Hematology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden. bjorn.wahlin@sll.se.
Abstract
BACKGROUND: Chimeric antigen-receptor T-cell and bispecific antibody therapies will likely necessitate a reconsideration of the role of autologous stem-cell transplantation (ASCT) in lymphoma. Patients who are likely to profit from ASCT need to be better identified. METHODS: Here, we investigated the value of positron emission tomography/computerized tomography (PET/CT) before ASCT. All 521 patients transplanted for lymphoma 1994-2019 at Karolinska (497 conditioned with BEAM) were included. RESULTS: Outcome improved over three calendar periods 1994-2004, 2005-2014, 2015-2019 (2-year overall survival [OS]: 66, 73, 83%; P = 0.018). Non-relapse mortality (NRM) at 100 days over the three periods were 9.8, 3.9, 2.9%, respectively. The OS improvement between 1994 and 2004 and 2005-2014 was due to lower NRM (P = 0.027), but the large OS advance from 2015 was not accompanied by a significant reduction in NRM (P = 0.6). The fraction of PET/CT as pre-ASCT assessment also increased over time: 1994-2004, 2%; 2005-2014, 24%; 2015-2019, 60% (P < 0.00005). Complete responses (PET/CT-CR) were observed in 77% and metabolically active partial responses (PET/CT-PR) in 23%. PET/CT-CR was a predictor for survival in the entire population (P = 0.0003), also in the subpopulations of aggressive B-cell (P = 0.004) and peripheral T-cell (P = 0.024) lymphomas. Two-year OS and progression-free survival (OS/PFS) for patients in PET/CT-CR were in relapsed/refractory aggressive B-cell lymphoma 87%/75% and peripheral T-cell lymphoma 91%/78%. The corresponding figures in PET/CT-PR were 43%/44 and 33%/33%. Patients with solitary PET/CT-positive lesions showed acceptable outcome with ASCT followed by local irradiation (2-year OS/PFS 80%/60%). CT was less discriminative: 2-year OS/PFS: CT-CR, 76%/66%; CT-PR, 62%/51%. Outcome was inferior after BEAC compared with BEAM conditioning. CONCLUSIONS: We conclude that the improved outcome reflects better, PET/CT-informed, identification of patients who should proceed to ASCT. The excellent survival of patients in PET/CT-CR indicates that ASCT should remain part of standard therapy for lymphoma.
BACKGROUND: Chimeric antigen-receptor T-cell and bispecific antibody therapies will likely necessitate a reconsideration of the role of autologous stem-cell transplantation (ASCT) in lymphoma. Patients who are likely to profit from ASCT need to be better identified. METHODS: Here, we investigated the value of positron emission tomography/computerized tomography (PET/CT) before ASCT. All 521 patients transplanted for lymphoma 1994-2019 at Karolinska (497 conditioned with BEAM) were included. RESULTS: Outcome improved over three calendar periods 1994-2004, 2005-2014, 2015-2019 (2-year overall survival [OS]: 66, 73, 83%; P = 0.018). Non-relapse mortality (NRM) at 100 days over the three periods were 9.8, 3.9, 2.9%, respectively. The OS improvement between 1994 and 2004 and 2005-2014 was due to lower NRM (P = 0.027), but the large OS advance from 2015 was not accompanied by a significant reduction in NRM (P = 0.6). The fraction of PET/CT as pre-ASCT assessment also increased over time: 1994-2004, 2%; 2005-2014, 24%; 2015-2019, 60% (P < 0.00005). Complete responses (PET/CT-CR) were observed in 77% and metabolically active partial responses (PET/CT-PR) in 23%. PET/CT-CR was a predictor for survival in the entire population (P = 0.0003), also in the subpopulations of aggressive B-cell (P = 0.004) and peripheral T-cell (P = 0.024) lymphomas. Two-year OS and progression-free survival (OS/PFS) for patients in PET/CT-CR were in relapsed/refractory aggressive B-cell lymphoma 87%/75% and peripheral T-cell lymphoma 91%/78%. The corresponding figures in PET/CT-PR were 43%/44 and 33%/33%. Patients with solitary PET/CT-positive lesions showed acceptable outcome with ASCT followed by local irradiation (2-year OS/PFS 80%/60%). CT was less discriminative: 2-year OS/PFS: CT-CR, 76%/66%; CT-PR, 62%/51%. Outcome was inferior after BEAC compared with BEAM conditioning. CONCLUSIONS: We conclude that the improved outcome reflects better, PET/CT-informed, identification of patients who should proceed to ASCT. The excellent survival of patients in PET/CT-CR indicates that ASCT should remain part of standard therapy for lymphoma.
Entities:
Keywords:
ASCT; Autologous stem-cell transplantation; B cell; Lymphoma; PET; PET/CT; Positron emission tomography/computerized tomography; T cell
Authors: Karoline Spaepen; Sigrid Stroobants; Patrick Dupont; Peter Vandenberghe; Johan Maertens; Guy Bormans; José Thomas; Jan Balzarini; Christine De Wolf-Peeters; Luc Mortelmans; Gregor Verhoef Journal: Blood Date: 2003-02-27 Impact factor: 22.113
Authors: Michael Dickinson; Rosemary Hoyt; Andrew W Roberts; Andrew Grigg; John F Seymour; H Miles Prince; Jeff Szer; David Ritchie Journal: Br J Haematol Date: 2010-05-07 Impact factor: 6.998
Authors: Amin M Alousi; Rima M Saliba; Grace-Julia Okoroji; Homer A Macapinlac; Chitra Hosing; Martin Korbling; Barry I Samuels; Uday Popat; Partow Kebriaei; Paolo Anderlini; Muzaffar H Qazilbash; Marcos de Lima; Sergio A Giralt; Richard E Champlin; Issa F Khouri Journal: Br J Haematol Date: 2008-06-17 Impact factor: 6.998
Authors: Bruce D Cheson; Richard I Fisher; Sally F Barrington; Franco Cavalli; Lawrence H Schwartz; Emanuele Zucca; T Andrew Lister Journal: J Clin Oncol Date: 2014-09-20 Impact factor: 44.544
Authors: Bart W Schot; Josée M Zijlstra; Wim J Sluiter; Gustaaf W van Imhoff; Jan Pruim; Willem Vaalburg; Edo Vellenga Journal: Blood Date: 2006-09-26 Impact factor: 22.113
Authors: Mattias Carlsten; Martin Jädersten; Anna Hellström; Karin Littmann; Christopher M Melén; Henna Riikka Junlén; Kristina Sonnevi; Per Ljungman; Bo Björkstrand; Björn Engelbrekt Wahlin Journal: Exp Hematol Oncol Date: 2019-03-18