title: High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS.
abstract: Doxorubicin-based immunochemotherapy, with interferon, has been shown to improve survival in patients with advanced follicular lymphoma. High-dose chemotherapy with stem-cell support is effective in follicular lymphoma in relapse but remains controversial as a first-line therapy. In a randomized study using a purged autologous stem-cell support, we compared these 2 approaches in patients with advanced follicular lymphoma. Newly diagnosed advanced follicular lymphoma patients (172 patients) were randomly assigned either to an immunochemotherapy regimen (cyclophosphamide, doxorubicin, teniposide, prednisone, and interferon) or to a high-dose therapy followed by purged autologous stem-cell transplantation. Compared with the patients who received chemotherapy and interferon, patients treated with high-dose therapy had a higher response rate (69% vs 81%, P = .045) and a longer median event-free survival (not reached vs 45 months). This did not translate into a better survival rate due to an excess of secondary malignancies after transplantation. The Follicular Lymphoma Prognostic Index identified a subgroup of patients with a significantly higher event-free survival rate after high-dose therapy. Autologous stem-cell transplantation cannot be considered as the standard first-line treatment of follicular lymphoma for patients younger than 60 years old with a high tumor burden.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale U645, Université de Besançon-Equipe d'Accueil 2284, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Charles
authors.initials: C
authors.lastname: Foussard
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertrand
authors.forename: Patrick
authors.initials: P
authors.lastname: Michenet
authors.forename: Pascale
authors.initials: P
authors.lastname: Cornillet-LeFebvre
authors.forename: Martine
authors.initials: M
authors.lastname: Escoffre-Barbe
authors.forename: Herve
authors.initials: H
authors.lastname: Maisonneuve
authors.forename: Vincent
authors.initials: V
authors.lastname: Delwail
authors.forename: Remy
authors.initials: R
authors.lastname: Gressin
authors.forename: Eric
authors.initials: E
authors.lastname: Legouffe
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vilque
authors.forename: Bernard
authors.initials: B
authors.lastname: Desablens
authors.forename: Jerome
authors.initials: J
authors.lastname: Jaubert
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ramee
authors.forename: Arash
authors.initials: A
authors.lastname: Jenabian
authors.forename: Antoine
authors.initials: A
authors.lastname: Thyss
authors.forename: Annick
authors.initials: A
authors.lastname: Le Pourhiet-Le Mevel
authors.forename: Philippe
authors.initials: P
authors.lastname: Travade
authors.forename: Roselyne
authors.initials: R
authors.lastname: Delepine
authors.forename: Philippe
authors.initials: P
authors.lastname: Colombat
mesh_terms: D000328:Adult; D018450:Disease Progression; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous
chemical_list: D004317:Doxorubicin