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JAMA Oncol. 2019 Feb 28. doi: 10.1001/jamaoncol.2018.6278. [Epub ahead of print]

Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation: A Consensus Project of ASBMT, CIBMTR, and the Lymphoma Working Party of EBMT.

Author information

1
Section of Hematology and Oncology, West Virginia University, Morgantown, West Virginia.
2
Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa.
3
University of Heidelberg, Heidelberg, Germany.
4
Department of Medicine III, University Hospital, LMU Munich, Germany.
5
Service d'Hématologie, Centre Hospitalo-Universitaire Nantes, Nantes, France.
6
Department of Oncology and Hematology, Fondazione Istituto Nazionale dei Tumori Milano University of Milano, Milano, Italy.
7
The Ottawa Hospital Bone Marrow Transplant Programme, University of Ottawa, Ottawa, Ontario, Canada.
8
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee.
9
Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois.
10
Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.
11
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
12
University of Rochester, Rochester, New York.
13
Division of Hematology, Mayo Clinic, Rochester, Minnesota.
14
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
15
Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida.
16
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
17
Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
18
University Hospital Bristol NHS Foundation Trust, London, United Kingdom.
19
Section of Hematology and Oncology, Cancer Treatment Centers of America, Zion, Illinois.
20
Hôpital Saint Louis, Paris, France.
21
Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha.
22
University of Washington, Fred Hutchinson Cancer Research Center, Seattle.
23
Center for International Blood and Marrow Transplant Research, Wisconsin.

Abstract

Importance:

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.

Observations:

The RAND-modified Delphi method was used to generate consensus statements where at least 75% vote in favor of a recommendation was considered as consensus. The process included 3 online surveys moderated by an independent methodological expert to ensure anonymity and an in-person meeting. The panel recommended restricting the histologic categories covered in this project to Hodgkin lymphoma (HL), mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma. On completion of the voting process, the panel generated 22 consensus statements regarding post auto-HCT maintenance and/or consolidation therapies. The grade A recommendations included endorsement of: (1) brentuximab vedotin (BV) maintenance and/or consolidation in BV-naïve high-risk HL, (2) rituximab maintenance in MCL undergoing auto-HCT after first-line therapy, (3) rituximab maintenance in rituximab-naïve FL, and (4) No post auto-HCT maintenance was recommended in DLBCL. The panel also developed consensus statements for important real-world clinical scenarios, where randomized data are lacking to guide clinical practice.

Conclusions and Relevance:

In the absence of contemporary evidence-based data, the panel found RAND-modified Delphi methodology effective in providing a rigorous framework for developing consensus recommendations for post auto-HCT maintenance and/or consolidation therapies in lymphoma.

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