Does Upfront Autologous Stem Cell Transplant at First Relapse Improve Outcome in Transplant Eligible Follicular Lymphoma Patients Who Relapse within 24 Months

In Canadian adults, Follicular lymphoma (FL) is the most common subtype of NHL, Approximately 20% of patients with FL experience progression of disease (POD) within 2 years of first line chemoimmunotherapy. Those patients have an expected overall survival of less than 5 years.The optimal second-line treatment for these high-risk patients is unclear. We analyzed data from the blood and bone marrow transplantation Center at the Ottawa Hospital (TOH) to determine whether autologous hematopoietic cell transplant (ASCT) as upfront therapy for first relapse can improve outcomes in this high-risk FL subgroup. We identified 17 patients who underwent upfront ASCT between February 2012 and February 2019. All of them had relapsed within 24 months after their 1st Rituximab-based chemotherapy. The OS at 2-year and 5-year was 86.2% (95% CI: 55-96) and 71.8% (95% CI: 31-91) respectively. The PFS at 2 year and 5 year was 62.6% (95% CI: 35-81) and 53.6% (95% CI: 25-75) respectively. We demonstrate improved OS when receiving autologous hematopoietic stem cell transplant as up front at first relapse in transplant eligible follicular lymphoma who relapse within 24 months of first line therapy. However; the sample size considerably small but the results look promising. Combining other center experience the confidence intervals are wide, indicating that the sample size was too small. Considering a single center, the result looks promising, but the data need to be replicated with a larger sample size.