By Marilynn Larkin
NEW YORK (Reuters Health) - 7/3/2019
Maintenance therapy guidelines for lymphoma patients who have undergone autologous hematopoietic cell transplantation (HCT) were recently released by an expert panel from the American Society for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and European Society for Blood and Marrow Transplantation.
Such treatments are often used to prevent disease relapse, Dr. Mehdi Hamadani of the Medical College of Wisconsin in Milwaukee told Reuters Health, "but no formal consensus statements (had) been published to guide clinical decision making."
The expert panel used an analytical technique, the RAND-modified Delphi method, to generate consensus statements where a vote in favor of a recommendation by at least 75% of panel members was considered a consensus. The process included three online surveys moderated by an independent expert. Panel members mostly practiced in academic settings (96%) and were transplant physicians with or without non-HCT lymphoma practices.
Histologic categories covered by the project were restricted to Hodgkin lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. At completion, the panel had generated 22 consensus statements regarding post auto-HCT maintenance and/or consolidation therapies.
Highlights of the guidelines, published online February 28 in JAMA Oncology, include the following, Dr. Hamadani said by email:
The panel recommended brentuximab vedotin maintenance/consolidation in high-risk Hodgkin lymphoma patients after autologous transplantation, including patients with brief brentuximab vedotin exposure (less 4-6 cycles) prior to transplantation.
Based on published survival benefit, the panel endorsed the use of rituximab maintenance in mantle cell lymphoma patients undergoing transplantation.
The panel unanimously recommended against rituximab maintenance in patients with diffuse large B-cell lymphoma, due to lack of evidence suggesting a benefit with this approach.
Dr. Samer Al-Homsi, director of the Blood and Marrow Transplant Program at NYU Langone's Perlmutter Cancer Center in New York City, pointed to the authors' statement, "We also acknowledge that these consensus statements are not a substitute for prospective controlled data."
Until such data is available, he told Reuters Health by email, "transplant physicians must objectively examine available evidence and combine it with common sense to reach a decision that is sound and specific to a given case."
JAMA Oncol 2019.