Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma

Abstract

Summary:Although follicular lymphoma (FL) is generally responsive to conventional-dose chemotherapy, improved survival in patients with this disease has been difficult to demonstrate. High-dose chemo/radiotherapy followed by autologous stem-cell transplantation (ASCT) can improve response rates, although its effects on survival remain controversial. Between 1990 and 2003, we transplanted 49 patients with low-grade FL at our institution. Twenty-two patients (45%) had undergone histologic transformation at the time of ASCT. In all, 44 patients (90%) had relapsed disease and five patients (10%) were resistant to chemotherapy at the time of transplantation. After ASCT, 30 patients (61%) were in complete remission (CR). The median overall survival (OS) has not been reached, while the median event-free survival (EFS) is 2.4 years. At a median follow-up of 5.5 years (longest 12.4 years), a plateau has been reached with 56% of patients remaining alive, and 35% event-free. ASCT was well tolerated except for two (4%) treatment-related deaths. In multivariable analysis, CR after ASCT and age less than 60 years are the best predictors of EFS and OS. ASCT is thus a safe therapeutic approach in FL, resulting in long-term EFS and OS for some patients, even with transformed disease. Bone Marrow Transplantation (2005) 36, 955-961.

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

“…Data, mainly from the pre-rituximab era, indicate that the outcome of tFL is improved by HDT-ASCT, i.e. OS increased from approximately 1.5 to 3.5 to 6 years [8][9][10][11][15][16][17][18][19][20][21]. It is however uncertain to what extent this still applies in the rituximab era.…”

“…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).…”

Transformation of follicular lymphoma

“…Therefore, a biopsy should be performed at the time of post ASCT relapse to establish the subtype of the relapsed lymphoma. High LDH levels and presence of residual disease or chemoresistance at the time of transplantation[120, 122]and advanced age[119, 122] were associated with shorter post ASCT OS and PFS. Comparison of the transplantation outcomes between patients with transformed and non-transformed FL or de novo DLBCL demonstrated no significant differences in OS and PFS in some studies[118, 120], while others suggested inferior outcome for patients with transformed FL [122].…”

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.…”