Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma.
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.
Andreadis
C
C
Bone Marrow & Stem Cell Transplantation Program and Lymphoma Program, The Abramson Cancer Center, University of Pennsylvania, 16 Penn Tower, 3400 Spruce Street, Philadelphia, 19104, USA. babis.andreadis@uphs.upenn.edu
Schuster
S J
SJ
Chong
E A
EA
Svoboda
J
J
Luger
S M
SM
Porter
D L
DL
Tsai
D E
DE
Nasta
S D
SD
Elstrom
R L
RL
Goldstein
S C
SC
Downs
L H
LH
Mangan
P A
PA
Cunningham
K A
KA
Hummel
K A
KA
Gimotty
P A
PA
Siegel
D L
DL
Glatstein
E
E
Stadtmauer
E A
EA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents