High-dose therapy with autologous stem cell transplantation versus chemotherapy or immuno-chemotherapy for follicular lymphoma in adults

Abstract

In summary, the currently available evidence suggests a strong PFS benefit for HDT + ASCT compared with chemotherapy or immuno-chemotherapy in previously untreated patients with FL. No statistically significant differences in terms of OS, TRM and secondary cancers were detected. These effects are confirmed in a subgroup analysis (one trial) adding rituximab to both treatment arms. Further trials evaluating this approach are needed to determine this effect more precisely in the era of rituximab. Moreover, longer follow-up data are necessary to find out whether the PFS advantage will translate into an OS advantage in previously untreated patients with FL.There is evidence that HDT + ASCT is advantageous in patients with relapsed FL.

FDG PET-CT in follicular lymphoma: a case-based evidence review

“…36,37 Consolidation of first remission using high-dose chemotherapy and autologous stem cell transplant, and maintenance using scheduled rituximab, improve disease control but not overall survival. 38,39 Nonetheless, certain high-risk subgroups may achieve greater benefit with postinduction therapy, including transplant, rituximab maintenance, or incorporation of novel agents, and are a high-priority group for inclusion in prospective clinical trials.…”

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

“…64 A recent meta-analysis from the Cochrane group did not demonstrate an increased risk of second malignancies in patients from the first-line RCTs of ASCT vs observation, although these data lack longer follow-up periods. 65 An institutional review from the Dana-Farber Cancer Institute with a 12-year follow-up of patients undergoing ASCT as consolidation of primary therapy reported a second malignancy incidence of 28%. 66 In these 27 patients, the malignancies included 10 cases of therapy-related myelodysplastic syndrome (T-MDS) or therapy-related acute myeloid leukemia (T-AML), 2 other hematologic malignancies, 9 solid tumors, and 10 nonmelanoma skin cancers.…”

Consolidative autologous hematopoietic stem-cell transplantation in first remission for non-Hodgkin lymphoma: current indications and future perspective

“…Notably, over 80% of patients randomized to receive ASCT successfully completed ASCT, but there was heterogeneity in the induction chemotherapy regimens, control group chemotherapeutic regimens, and only one trial involved rituximab [Ladetto et al 2008]. Also of note, the meta-analysis by Schaaf and colleagues in 2012 compared the rates of treatment-related mortality, secondary acute myeloid leukemia, secondary myelodysplastic syndrome, and secondary solid malignancies in patients receiving ASCT compared with chemotherapy alone, and there was no statistically significant difference [Schaaf et al 2012]. However, it should be noted that there was a trend toward increased risk of secondary cancers in patients receiving high-dose induction therapy followed by ASCT compared with control patients in three of the RCTs [Lenz et al 2004;Sebban et al 2006;Gyan et al 2009].…”