Table 3.
Final clinical practice guidelines consensus statements on maintenance therapy after high dose therapy and autologous hematopoietic cell transplantation for diffuse large B-cell and follicular lymphoma
| Consensus Statements – Diffuse Large B-cell Lymphoma and Follicular Lymphoma | Grading of Recommendations† | Percentage of Panelists in Agreement |
|---|---|---|
| Diffuse Large B-cell Lymphoma | ||
| 1. The panel does not recommend post autologous HCT maintenance therapy with rituximab for relapsed/refractory DLBCL that is sensitive to rituximab-based salvage approaches. | A | 100% |
| 2. Regarding autologous HCT for high-risk DLBCL (high-risk IPI score, double/triple hit, double expressor, and/or those with failure of first line therapy within 1 year of diagnosis), either in the upfront or relapsed/refractory setting, the panel does not recommend post autologous HCT maintenance/consolidation therapy with rituximab. | C | 100% |
| 3. Regarding autologous HCT for DLBCL, maintenance/consolidation therapy with novel agents (e.g. monoclonal antibodies other than rituximab, bortezomib, lenalidomide, BTK inhibitors, BCL2 inhibitors, cellular therapies etc.) should only be offered on a clinical trial. | C | 100% |
| Follicular Lymphoma | ||
| 1. The panel recommends post autologous HCT maintenance therapy with rituximab (375 mg/m2 every 2 months for 4 doses) in for chemosensitive, relapsed, rituximab-naïve FL.* | A | 81% |
| 2. The panel recommends post autologous HCT maintenance therapy with rituximab in high-risk FL with early therapy failure (i.e. relapse or progression of disease within 24 months of diagnosis) and no evidence of rituximab resistance. | C | 77% |
| 3. The panel does not recommend post autologous HCT maintenance therapy with rituximab for rituximab-resistant FL (i.e. relapse or progression of FL while on, or within 6 months of receiving a rituximab-based treatment regimen or single agent rituximab) | C | 92% |
| 4. Regarding autologous HCT for FL, maintenance/consolidation therapy with novel agents (e.g. monoclonal antibodies other than rituximab, bortezomib, lenalidomide, PI3K inhibitors, bcl2 inhibitors etc.) should only be offered on a clinical trial. | C | 100% |
| 5. Acknowledging the lack of prospective data, the panel recommends post autologous HCT maintenance therapy with rituximab in chemosensitive, relapsed, previously rituximab (or other CD20 antibody)-treated FL, without any prior evidence of rituximab resistance. | B | 84% |
Abbreviation: HCT – hematopoietic cell transplantation; PET/CT – positron emission tomography/computed tomography; DLBCL – diffuse large B-cell lymphoma; IPI – international prognostic index; FL – follicular lymphoma
Consensus statement based on OS benefit seen in randomized trials
Agency of Healthcare Research and Quality (AHRQ) grading of recommendations based on level of evidence13:
A = There is good research-based evidence to support the recommendation;
B = There is fair research-based evidence to support the recommendation;
C = The recommendation is based on expert opinion and panel consensus:
X = There is evidence of harm from this intervention.