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.
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.
Deconinck
Eric
E
Institut National de la Santé et de la Recherche Médicale U645, Université de Besançon-Equipe d'Accueil 2284, France.
Foussard
Charles
C
Milpied
Noel
N
Bertrand
Philippe
P
Michenet
Patrick
P
Cornillet-LeFebvre
Pascale
P
Escoffre-Barbe
Martine
M
Maisonneuve
Herve
H
Delwail
Vincent
V
Gressin
Remy
R
Legouffe
Eric
E
Vilque
Jean-Pierre
JP
Desablens
Bernard
B
Jaubert
Jerome
J
Ramee
Jean-François
JF
Jenabian
Arash
A
Thyss
Antoine
A
Le Pourhiet-Le Mevel
Annick
A
Travade
Philippe
P
Delepine
Roselyne
R
Colombat
Philippe
P
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
D004317:Doxorubicin