26
Should high risk NHL get upfront autologous SCT?? Didier Blaise, MD AUBHO 2015,Bangkok August, 28th, 2015
Should high risk NHL get upfront autologous SCT??
Didier Blaise, MDAUBHO 2015,Bangkok
August, 28th, 2015
20-year long question
• 1995: Auto BMT vs Salvage Chemotherapy in relapsed chemo-sensible NHL; NEJM, T Philip et al
• 2000: LNH 87.2 Protocol: JCO, V Haioun et al• 2000-2012: Phases 2 and Meta-analyses• 2013: auto transplantation as consolidation for
agressive NHL; NEJM, P Stiff et al
LNH 87.2
3C Haioun et al, JCO, 2000
HD chemo with auto-SCT in 1rst-line treatment of aggressive NHL– Results of a comprehensive meta-analysis
4
Event Free Survival Overall Survival
A Greb et al, Cancer Treat Rev, 2007
CONCLUSIONS
• No evidence that HDCT improved OS and EFS in good risk NHL patients.
• The evidence for poor risk patients is inconclusive. • HDCT
– should not be further investigated in good risk patients with aggressive NHL
– but high quality studies in poor risk patients are warranted.
5A Greb et al, Cancer Treat Rev, 2007
Auto HSCT as Consolidation for Aggressive NHL
6P Stiff et al, NEJM, 2013
Auto Transplantation as Consolidation for Aggressive NHL
7P Stiff et al, NEJM, 2013
Auto Transplantation as Consolidation for Aggressive NHL
8P Stiff et al, NEJM, 2013
Auto Transplantation as Consolidation for Aggressive NHL
9P Stiff et al, NEJM, 2013
Auto Transplantation as Consolidation for Aggressive NHL
10P Stiff et al, NEJM, 2013
32%
Auto Transplantation as Consolidation for Aggressive NHL
• Early auto-SCT among high-intermediate or High Risk NHL– Higher EFS– Not different OS
• Impact of salvage therapy
• Early auto-SCT for High Risk NHL– Higher EFS– Higher OS
– But low number of patients
11P Stiff et al, NEJM, 2013
Long-term follow-up of Auto SCT
12BT Hill et al, BJH, 2011
Long-term follow-up of Auto SCT
13BT Hill et al, BJH, 2011
CONCLUSION
• International Prognostic index: useful – Good Risk: no indication of early auto-SCT– Intermediate risk: no indication of early auto-SCT– High risk: to be further investigated
• Clinical trials• Other prognostic factors?
14
Prognostic impact of pre-transplant computed tomography and 67gallium scanning in chemosensitive DLBC NHL in pts undergoing HSCT
15I Escobar et al, Ann Nucl med, 2008
Prognostic significance of interim 18F-FDG PET/CT after 3 or 4 cycles of R-CHOP chemotherapy in the trt of DLBC NHL
16DH Yang et al, EUR J Cancer, 2011
Concurrent Expression of MYC and BCL2 in DLBC NHL Treated With RCHOP
17N Johnson et al, JCO, 2012
CONCLUSION
• International Prognostic index: useful – Good Risk: no indication of early auto-SCT– Intermediate risk: no indication of early auto-SCT– High risk: to be further investigated
• Clinical trials• Other prognostic factors
– Pet-scan– MYC/BCL2 expression
• Auto SCT is not sufficient when no chemo-sensibility
18
Tandem Transplantations in LymphomaBest of Both Worlds
19N Gosh, BBMT, 2015YB Chen, BBMT, 2015
Tandem Transplantations in LymphomaBest of Both Worlds
20N Gosh, BBMT, 2015YB Chen, BBMT, 2015
Post-Transplant Immunommodulation
21
Current Recommandations
22
23A Sureda et al, BMT, 2015
24N Majhail et al, BBMT, 2015
CONCLUSION
• International Prognostic index: useful – Good Risk: no indication of early auto-SCT– Intermediate risk: no indication of early auto-SCT– High risk: to be further investigated
• Clinical trials• Other prognostic factors
– Pet-scan– MYC/BCL2 expression
• Auto SCT is not sufficient when no chemo-sensibility– Tandem auto-allo– Post-Transplant immunomodulation
25
26
