High-dose therapy and autologous stem-cell transplantation can improve event-free survival for indolent lymphoma: a study using patients as their own controls.
BACKGROUND
High-dose therapy (HDT) and autologous stem-cell transplantation (ASCT) remain controversial for indolent lymphoma patients.


METHODS
The study was designed to evaluate the benefit of this strategy by retrospectively comparing for each patient the event-free survival (EFS) after ASCT with the duration of the disease phase just before the phase including ASCT (ie, the last qualifying phase, LQP).


RESULTS
A total of 109 indolent lymphoma (mostly follicular lymphoma) patients were treated with HDT and ASCT. Before ASCT, patients experienced a median of 2 disease phases (range, 1-4). After a median 5-year follow-up from ASCT, overall survival was 67% and EFS was 43%. When each of the 92 patients experiencing recurrence was taken as her/his own control, EFS was longer after ASCT than the duration of LQP (62%, P < .01). During LQP, 86 patients (93%) experienced recurrence in less than 5 years, compared with only 58 (63%) who experienced recurrence in the 5 years after ASCT (P < .01).


CONCLUSIONS
HDT and ASCT can significantly increase EFS in comparison with the duration of the LQP for indolent lymphoma patients and can change disease course. This methodology has been found useful for evaluating new strategies, especially with monoclonal antibodies.
Vignot
Stéphane
S
Institut Universitaire d'Hématologie, INSERM U728, Hôpital Saint-Louis, Paris, France. stephane.vignot@sls.aphp.fr
Mounier
Nicolas
N
Larghero
Jérôme
J
Brice
Pauline
P
Quero
Laurent
L
de Bazelaire
Cédric
C
Ertault
Marjan
M
Brière
Josette
J
Madelaine
Isabelle
I
Gisselbrecht
Christian
C
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000628:therapy*; D008224:Lymphoma, Follicular / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents