title: Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma.
abstract: 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.
authors.affiliation: 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
authors.forename: C
authors.initials: C
authors.lastname: Andreadis
authors.forename: S J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: E A
authors.initials: EA
authors.lastname: Chong
authors.forename: J
authors.initials: J
authors.lastname: Svoboda
authors.forename: S M
authors.initials: SM
authors.lastname: Luger
authors.forename: D L
authors.initials: DL
authors.lastname: Porter
authors.forename: D E
authors.initials: DE
authors.lastname: Tsai
authors.forename: S D
authors.initials: SD
authors.lastname: Nasta
authors.forename: R L
authors.initials: RL
authors.lastname: Elstrom
authors.forename: S C
authors.initials: SC
authors.lastname: Goldstein
authors.forename: L H
authors.initials: LH
authors.lastname: Downs
authors.forename: P A
authors.initials: PA
authors.lastname: Mangan
authors.forename: K A
authors.initials: KA
authors.lastname: Cunningham
authors.forename: K A
authors.initials: KA
authors.lastname: Hummel
authors.forename: P A
authors.initials: PA
authors.lastname: Gimotty
authors.forename: D L
authors.initials: DL
authors.lastname: Siegel
authors.forename: E
authors.initials: E
authors.lastname: Glatstein
authors.forename: E A
authors.initials: EA
authors.lastname: Stadtmauer
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents