Upfront AutoSCT in High Risk NHL. Didier Blaise

1. Should high risk NHL get
upfront autologous SCT??
Didier Blaise, MD
AUBHO 2015,Bangkok
August, 28th, 2015

2. 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

3. LNH 87.2
3C Haioun et al, JCO, 2000

4. 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

5. 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.
5
A Greb et al, Cancer Treat Rev, 2007

6. Auto HSCT as Consolidation
for Aggressive NHL
6
P Stiff et al, NEJM, 2013

7. Auto Transplantation as Consolidation for
Aggressive NHL
7
P Stiff et al, NEJM, 2013

8. Auto Transplantation as Consolidation for
Aggressive NHL
8
P Stiff et al, NEJM, 2013

9. Auto Transplantation as Consolidation for
Aggressive NHL
9
P Stiff et al, NEJM, 2013

10. Auto Transplantation as Consolidation for
Aggressive NHL
10
P Stiff et al, NEJM, 2013
32%

11. 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
11
P Stiff et al, NEJM, 2013

12. Long-term follow-up of Auto SCT
12
BT Hill et al, BJH, 2011

13. Long-term follow-up of Auto SCT
13
BT Hill et al, BJH, 2011

14. 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

15. Prognostic impact of pre-transplant computed
tomography and 67gallium scanning in chemosensitive
DLBC NHL in pts undergoing HSCT
15
I Escobar et al, Ann Nucl med, 2008

16. Prognostic significance of interim 18F-FDG
PET/CT after 3 or 4 cycles of R-CHOP
chemotherapy in the trt of DLBC NHL
16
DH Yang et al, EUR J Cancer, 2011

17. Concurrent Expression of MYC and BCL2 in
DLBC NHL Treated With RCHOP
17
N Johnson et al, JCO, 2012

18. 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

19. Tandem Transplantations in Lymphoma
Best of Both Worlds
19
N Gosh, BBMT, 2015
YB Chen, BBMT, 2015

20. Tandem Transplantations in Lymphoma
Best of Both Worlds
20
N Gosh, BBMT, 2015
YB Chen, BBMT, 2015

21. Post-Transplant Immunommodulation
21

22. Current Recommandations
22

23. 23
A Sureda et al, BMT, 2015

24. 24
N Majhail et al, BBMT, 2015

25. 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

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