A 15-Year Analysis of Early and Late Autologous Hematopoietic Stem Cell Transplant in Relapsed, Aggressive, Transformed, and Nontransformed Follicular Lymphoma

Abstract

Autologous stem cell transplant (ASCT) has been shown to be an effective treatment for follicular lymphoma (FL). We explored our experience in ASCT for FL among all patients treated over a 15-year period from diagnosis through their entire treatment history including relapse post ASCT. All patients who underwent an unpurged ASCT for relapsed, advanced FL between June 1990 and December 2000 were analyzed. After salvage therapy they received melphalan/etoposide/total body irradiation, BCNU, etoposide, cytarabine, melphalan (BEAM), or cyclophosphamide BCNU etoposide (CBV) as conditioning for the ASCT. One hundred thirty-eight patients with a median age of 48 years and a median follow-up of 7.6 years were analyzed. The majority were of the subtype grade 1, nontransformed (FL-NT), having had 1 prior chemotherapy. The progression-free (PFS) and overall survival (OS) of the FL-NT at 10 years were 46% and 57%, respectively, and at 5 years for the transformed (FL-T) were 25% and 56%, respectively, of which only the PFS was significantly different (P=.007). The median OS from diagnosis was 16 years for the FL-NT. ASCT positively altered the trend of shorter remissions with subsequent chemotherapies, and there was no difference in OS between those who had 1, 2, or >2 chemotherapies prior to ASCT. Salvage therapy for relapse post ASCT was effective (OS>1 year) in a third of patients. Unpurged ASCT is an effective tool in the treatment of relapsed, aggressive FL-NT and FL-T, is superior to retreatment with standard chemotherapy, is effective at various stages of treatment, is likely to have a beneficial influence on the natural history of this disease, and the disease is amenable to salvage therapy post-ASCT relapse.

Contaminating tumour cells in autologous PBSC grafts do not influence survival or relapse following transplant for multiple myeloma or B-cell non-Hodgkin's lymphoma

“…In particular, the high-dose treatment regimen used for the treatment of follicular lymphoma and other indolent NHL subtypes at our centre includes TBI and has been associated with favourable longterm results. 23 A TBI-containing regimen may have been sufficient for overcoming possible differences in disease burden in our patients with follicular lymphoma who were positive by PCR. Aggressive histology lymphomas such as diffuse large B-cell lymphoma and Burkitt-like lymphoma may remain sufficiently sensitive to the conditioning regimen to achieve long-term disease control, independent of potentially sensitive markers of disease burden such as graft populations of clonal B cells.…”

High dose chemotherapy with autologous stem cell support for patients with histologically transformed B‐cell non‐Hodgkin lymphomas. A Norwegian multi centre phase II study

“…Forty-seven patients were included on an intention-to-treat basis. This constitutes a large patient cohort with respect to most previous retrospective analyses (Schouten et al, 1989;Bastion et al, 1995;Foran et al, 1998;Friedberg et al, 1999;Berglund et al, 2000;Cao et al, 2001;Chen et al, 2001;Williams et al, 2001;Andreadis et al, 2005;Sabloff et al, 2007;Hamadani et al, 2008). The patients were recruited from all five Norwegian regional centres performing HDT and were representative of the population of patients younger than 65 years at a national level.…”

Preferences of patients and physicians concerning treatment options for relapsed follicular lymphoma: a discrete choice experiment

“…As opposed to the lack of published longterm data related to allo-SCT, long-term results beyond 10 years following auto-SCT report plateaus on PFS curves for studies specifically addressing follicular lymphoma patients transplanted prior to third or later relapse. 13,[26][27][28] Therefore, issue of 'cure' for follicular lymphoma is controversial, and dramatically increasing the number of required scenarios by adding another attribute to the questionnaire was considered to be unjustified. A 5-year period of PFS was considered to be a reasonable measure of treatment effectiveness for the purpose of this study.…”