In a consensus report published in JAMA Oncology, an expert panel provided recommendations for maintenance and consolidation therapy following autologous hematopoietic cell transplantation (autoHCT) in patients with lymphoma.
The panel comprised experts from the American Society for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the European Society for Blood and Marrow Transplantation. The panelists completed 3 online surveys regarding treatments for Hodgkin lymphoma (HL), mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL). For any recommendation, consensus was defined as 75% agreement among the 26 panelists.
The panel developed 22 consensus recommendations and rated each one according to the quality of evidence upon which it was based; an “A” rating represented the highest quality. Some recommendations with an “A” rating included:
- A brentuximab vedotin dosing schedule for patients with HL and brentuximab vedotin as consolidation or maintenance therapy after autoHCT in brentuximab vedotin-naive patients with high-risk HL;
- A rituximab dosing schedule for patients with MCL, and rituximab maintenance following first-line rituximab-based therapy after autoHCT;
- Avoidance of rituximab maintenance following autoHCT in patients with relapsed or refractory DLBCL sensitive to rituximab-based salvage therapy; and
- Rituximab maintenance in rituximab-naive patients with relapsed and chemosensitive FL.
Furthermore, “the panel unanimously voted to discourage the off-label use of novel agents as maintenance and/or consolidation therapies after autoHCT and recommend such use only in the context of a clinical trial.”
The authors noted that the level of available evidence supporting most of their consensus recommendations was limited but indicated that they prioritized providing guidance that identified gaps in information.
- Kanate AS, Kumar A, Dreger P, et al. Maintenance therapies for Hodgkin and non-Hodgkin lymphomas after autologous transplantation: a consensus project of ASBMT, CIBMTR, and the Lymphoma Working Party of EBMT [published online February 28, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.6278