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

Abstract

SummaryWe present a prospective phase II study of patients with relapse after chemotherapy showing transformation of follicular lymphoma to diffuse large B‐cell lymphoma, performed before rituximab was included in standard treatment. Patients in complete (CR) or partial remission (PR) after salvage chemotherapy were eligible for high‐dose chemotherapy with autologous stem cell support (HDT). Forty‐seven patients from five Norwegian centres were included, of whom 30 (63%) received HDT. Eighteen (60%) achieved CR, seven (23%) PR and five (10%) had progressive disease following HDT. Median follow‐up for the surviving patients was 75 months; median progression‐free (PFS) and overall survival (OS) were 26 and 47 months, respectively. Median OS for all patients was 43 months, compared to only 10 months for patients not eligible for HDT. Patients receiving CD34+ enriched/B‐cell depleted grafts had inferior PFS and a trend for inferior OS compared to patients receiving non‐purged grafts (Log Rank 0·025 and 0·151, respectively). In conclusion, two thirds of patients with transformation of follicular lymphoma were eligible for HDT. The majority of patients achieved CR and a considerable number had prolonged OS. The use of in vitro purged grafts did not result in a survival benefit compared to that of non‐purged grafts.

Transformed follicular non-Hodgkin lymphoma

“…47,[50][51][52][53] Given the heterogeneity in follow-up, inclusion of various indolent histologies, sample size, and other variables, direct comparison between these studies is problematic. Nearly all included patients were highly selected and young, with a median age in the 40s across most, [51][52][53][54][55] though not all studies, 47,56,57 and only minimal or no disease at time of ASCT. A multicenter Norwegian study of 47 patients is the only prospective series evaluating HDT and ASCT in patients with HT of FL, though conducted in the prerituximab era.…”

“…A multicenter Norwegian study of 47 patients is the only prospective series evaluating HDT and ASCT in patients with HT of FL, though conducted in the prerituximab era. 57 Two-thirds of patients were chemoresponsive (in either complete remission or partial remission) and permitted to receive HDT. This study did not complete its planned accrual, though outcomes here were similar to those seen in older retrospective studies, with 5-year rates of PFS and OS of 32% and 47% (Table 1).…”

Impact of prior treatment on outcome of transformed follicular lymphoma and relapsed de novo diffuse large B cell lymphoma: a retrospective multicentre analysis

“…In the pre-rituximab era, conventional chemotherapy resulted in post-transformation 5-year median overall survival (OS5) below 25 % [8][9][10][12][13][14]. To improve this, high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) was incorporated, leading to OS5 rates around 50 % [11,[15][16][17][18][19][20][21]. As a consequence, HDT-ASCT became a widely accepted treatment strategy in suitable patients with transformed follicular lymphoma (tFL).…”

18F-FDG or 3′-Deoxy-3′-18F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

“…Histologic transformation into an aggressive lymphoma occurs in 17%, 28%, and 37% of FL patients after 5, 10, and 15 y, respectively, with an apparent plateau at 15 y, after which transformation rarely seems to occur (1). There is increasing evidence that autologous consolidation of transformation of FL (TF) patients as first-line treatment may improve survival (2)(3)(4). Furthermore, retrospective analyses suggest that patients can be cured more often when transformation is diagnosed at an early stage (5,6).…”