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).
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.
Ladetto
Marco
M
Divisione Universitaria di Ematologia, Cattedra di Ematologia, Ospedale S. Giovanni Vecchio antica sede, Torino, Italy. marco.ladetto@unito.it
Corradini
Paolo
P
Vallet
Sonia
S
Benedetti
Fabio
F
Vitolo
Umberto
U
Martelli
Maurizio
M
Brugiatelli
Maura
M
Coser
Paolo
P
Perrotti
Alessio
A
Majolino
Ignazio
I
Fioritoni
Giuseppe
G
Morandi
Sergio
S
Musso
Maurizio
M
Zambello
Renato
R
Chisesi
Teodoro
T
Di Renzo
Nicola
N
Vivaldi
Paolo
P
De Crescenzo
Alberto
A
Gallamini
Andrea
A
Salvi
Flavia
F
Santini
Gino
G
Boccomini
Carola
C
Sorio
Marco
M
Astolfi
Monica
M
Drandi
Daniela
D
Pileri
Alessandro
A
Tarella
Corrado
C
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