Practical Research 1 Lesson 9 Scope and delimitation.pptx
Upfront AutoSCT in High Risk NHL
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
4. HD chemo with auto-SCT in 1rst-line treatment of aggressive
NHL– Results of a comprehensive meta-analysis
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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.
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A Greb et al, Cancer Treat Rev, 2007
6. Auto HSCT as Consolidation
for Aggressive NHL
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P Stiff et al, NEJM, 2013
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
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P Stiff et al, NEJM, 2013
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?
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15. Prognostic impact of pre-transplant computed
tomography and 67gallium scanning in chemosensitive
DLBC NHL in pts undergoing HSCT
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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
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DH Yang et al, EUR J Cancer, 2011
17. Concurrent Expression of MYC and BCL2 in
DLBC NHL Treated With RCHOP
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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
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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
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