title: High rate of clinical and molecular remissions in follicular lymphoma patients receiving high-dose sequential chemotherapy and autografting at diagnosis: a multicenter, prospective study by the Gruppo Italiano Trapianto Midollo Osseo (GITMO).
abstract: Single-center experiences have shown that intensified treatments with autologous transplantation are a promising therapeutic strategy for patients with high-risk follicle-center lymphoma (FCL) at diagnosis, whereas data from prospective multicenter trials are still lacking. This paper describes the results of a prospective multicenter study of an intensified purging-free high-dose sequential (i-HDS) chemotherapy schedule with peripheral blood progenitor cell (PBPC) autografting. The main feature of this program is harvesting stem cells after intensified chemotherapeutic debulking, with no ex vivo manipulation of PBPCs. Ninety-two previously untreated patients aged 60 or younger with advanced-stage FCL were enrolled by 20 Italian centers and evaluated on an intention-to-treat basis. i-HDS proved feasible with limited toxicity (87% patients completed the planned treatment schedule). i-HDS led to a complete remission rate of 88%. The projected overall survival and disease-free survival (DFS) were, respectively, 84% and 67% at 4 years. Centralized molecular analysis showed that polymerase chain reaction-negative harvests could be collected in 47% of cases. Following autograft, 65% of molecularly evaluable patients achieved clinical and molecular remission. The projected DFS at 4 years of this subgroup is 85%. This result emphasizes the importance of achieving maximal tumor reduction in these patients. In conclusion, our data show that highly effective intensified treatments can now be routinely offered to young patients with poor-risk FCL even at small institutions, with no need for sophisticated and expensive cell manipulation procedures.
authors.affiliation: Divisione Universitaria di Ematologia, Cattedra di Ematologia, Ospedale S. Giovanni Vecchio antica sede, Torino, Italy. marco.ladetto@unito.it
authors.forename: Marco
authors.initials: M
authors.lastname: Ladetto
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Sonia
authors.initials: S
authors.lastname: Vallet
authors.forename: Fabio
authors.initials: F
authors.lastname: Benedetti
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Coser
authors.forename: Alessio
authors.initials: A
authors.lastname: Perrotti
authors.forename: Ignazio
authors.initials: I
authors.lastname: Majolino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fioritoni
authors.forename: Sergio
authors.initials: S
authors.lastname: Morandi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Musso
authors.forename: Renato
authors.initials: R
authors.lastname: Zambello
authors.forename: Teodoro
authors.initials: T
authors.lastname: Chisesi
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.forename: Paolo
authors.initials: P
authors.lastname: Vivaldi
authors.forename: Alberto
authors.initials: A
authors.lastname: De Crescenzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Flavia
authors.initials: F
authors.lastname: Salvi
authors.forename: Gino
authors.initials: G
authors.lastname: Santini
authors.forename: Carola
authors.initials: C
authors.lastname: Boccomini
authors.forename: Marco
authors.initials: M
authors.lastname: Sorio
authors.forename: Monica
authors.initials: M
authors.lastname: Astolfi
authors.forename: Daniela
authors.initials: D
authors.lastname: Drandi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pileri
authors.forename: Corrado
authors.initials: C
authors.lastname: Tarella
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007558:Italy; D008224:Lymphoma, Follicular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous