Last updated March 15, 2022

Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation

Consensus Statements

Hodgkin Lymphoma

1. The panel recommends post–autologous HCT consolidation/maintenance with BV for 16 cycles in BV-naïve classic Hodgkin lymphoma (HL) with at least 1 or more high-risk features as defined by the AETHERA study.a ( A )
609
2. The panel does not recommend postautologous HCT consolidation/ maintenance with BV for HL with prior evidence of disease refractory to BV. ( C )
609
3. The recommended duration of post–auto-HCT BV consolidation/maintenance therapy is for a maximum of 16 cycles every 3 weeks as described in AETHERA trial, or until unacceptable toxicity or disease relapse/progression (whichever occurs first).a ( A )
609
4. The panel recommends post–autologous HCT consolidation/ maintenance with BV in HL with one or more high-risk features as defined by the AETHERA trial and limited prior exposure to BV (approximately 4-6 cycles) preceding the autologous HCT, but without any evidence of BV refractory disease. ( C )
609
5. Sufficient data do not exist to use the preautologous-HCT PET (or PET/CT) scan status to guide the use of post–autologous HCT consolidation/maintenance therapy with BV for HL with one or more high-risk features as defined by AETHERA Trial. ( C )
609

a Consensus statement based on observed PFS benefit, but no OS benefit in randomized clinical trials.

Mantle Cell Lymphoma

1. Regarding upfront autologous HCT for chemosensitive MCL after 1 line of prior rituximab and cytarabine-containing therapy, the panel recommends maintenance therapy with rituximab every 2 months for 3 y.a ( A )
609
2. Regarding upfront autologous HCT for chemosensitive MCL, the panel recommends maintenance therapy with rituximab (every 2 months for 3 y), regardless of the type of pretransplant induction treatment. ( B )
609
3. Regarding upfront autologous HCT for MCL with a pretransplantation PET (or PET/CT) scan of Deauville score of 1-3, the panel recommends postautologous HCT rituximab maintenance therapy. ( C )
609
4. Regarding upfront autologous HCT for chemosensitive MCL with no evidence of pretransplant minimal residual disease by PCR or next-generation sequencing, the panel recommends maintenance therapy with rituximab.a ( C )
609
5. Recommended duration of postautologous-HCT rituximab maintenance therapy in MCL is every 2 mo for a maximum of 3 years as described in LYSA trial, or until unacceptable toxicity or disease relapse/progression (whichever occurs first).a ( A )
609
6. After autologous HCT for MCL, maintenance/consolidation therapy with agents other than rituximab (eg, bortezomib, lenalidomide, BTK inhibitors, BCL2 inhibitors, etc) should only be offered in a clinical trial. ( C )
609
7. The panel does not recommend postautologous HCT rituximab maintenance/consolidation for rituximab-resistant MCL (ie, relapse or progression of MCL while on, or within 6 mo of receiving a rituximab-containing treatment regimen). ( C )
609
8. Regarding MCL patients undergoing a delayed autologous HCT who have not received rituximab maintenance previously and have demonstrated no evidence of rituximab resistance, the panel recommends postautologous HCT maintenance therapy with rituximab. ( C )
609
9. Regarding patients with MCL undergoing a delayed autologous HCT who have previously received rituximab maintenance but have demonstrated no evidence of rituximab resistance, the panel recommends postautologous HCT maintenance therapy with rituximab. ( C )
609
a Consensus statement based on overall survival benefit seen in randomized clinical trials.

Diffuse Large B-cell Lymphoma

1. The panel does not recommend postautologous HCT maintenance therapy with rituximab for relapsed or refractory DLBCL that is sensitive to rituximab-based salvage approaches. ( A )
609
2. Regarding autologous HCT for high-risk DLBCL (high-risk IPI score, double or triple hit, double expressor, and/or those with failure of first-line therapy within 1 y of diagnosis), either in the upfront or relapsed or refractory setting, the panel does not recommend postautologous HCT maintenance/consolidation therapy with rituximab. ( C )
609
3. Regarding autologous HCT for DLBCL, maintenance/consolidation therapy with novel agents (eg, monoclonal antibodies other than rituximab, bortezomib, lenalidomide, BTK inhibitors, BCL2 inhibitors, cellular therapies, etc) should only be offered in a clinical trial. ( C )
609

Follicular Lymphoma

 1. The panel recommends postautologous HCT maintenance therapy with rituximab (375 mg/m2 every 2 mo for 4 doses) for chemosensitive, relapsed, rituximab-naïve FL.a ( A )
609
2. The panel recommends postautologous HCT maintenance therapy with rituximab in high-risk FL with early therapy failure (ie, relapse or progression of disease within 24 mo of diagnosis) and no evidence of rituximab resistance. ( C )
609
3. The panel does not recommend postautologous HCT maintenance therapy with rituximab for rituximab-resistant FL (ie, relapse or progression of FL while on or within 6 mo of receiving a rituximab-based treatment regimen or single agent rituximab). ( C )
609
4. Regarding autologous HCT for FL, maintenance and/or consolidation therapy with novel agents (eg, monoclonal antibodies other than rituximab, bortezomib, lenalidomide, PI3K inhibitors, BCl2 inhibitors, etc) should only be offered in a clinical trial. ( C )
609
5. Acknowledging the lack of prospective data, the panel recommends postautologous HCT maintenance therapy with rituximab in chemosensitive, relapsed, previously rituximab (or other CD20 antibody)-treated FL, without any prior evidence of rituximab resistance. ( B )
609
a Consensus statement based on overall survival benefit seen in randomized clinical trials.

BV, brentuximab vedontin; DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; HCT, hematopoietic cell transplantation; HL, Hodgkin lymphoma; MCL, mantle cell lymphoma; IPI, International Prognostic Index; PET/CT, positron emission tomography/computed tomography 

Recommendation Grading

Overview

Title

Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation

Authoring Organization

Publication Month/Year

February 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Maintenance therapies are often considered as a therapeutic strategy in patients with lymphoma following autologous hematopoietic cell transplantation (auto-HCT) to mitigate the risk of disease relapse. With an evolving therapeutic landscape, where novel drugs are moving earlier in therapy lines, evidence relevant to contemporary practice is increasingly limited. The American Society for Blood and Marrow Transplantation (ASBMT), Center for International Blood and Marrow Transplant Research (CIBMTR), and European Society for Blood and Marrow Transplantation (EBMT) jointly convened an expert panel with diverse expertise and geographical representation to formulate consensus recommendations regarding the use of maintenance and/or consolidation therapies after auto-HCT in patients with lymphoma.

Target Patient Population

Patients with Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D008223 - Lymphoma, D014180 - Transplantation, D014182 - Transplantation, Autologous, D006405 - Hematology

Keywords

stem cell transplantation, transplant, hematologic malignancies, lymphoma, oncology

Source Citation

JAMA Oncol. 2019;5(5):715-722. doi:10.1001/jamaoncol.2018.6278