Long-term follow-up of high-dose treatment with autologous haematopoietic progenitor cell support in 693 patients with follicular lymphoma: an EBMT registry study.
To evaluate the outcome of a large series of patients who received high-dose treatment (HDT) for follicular lymphoma (FL), 693 patients undergoing HDT (total-body irradiation (TBI)-containing regimen: 58%; autologous bone marrow (BM)/peripheral blood progenitor cells (PBPCs): 378/285 patients) were included in the study. A total of 375 patients (54%) developed recurrent lymphoma, 10-year progression-free survival (PFS) being 31%. On multivariate analysis, younger age (P=0.003) and HDT in first complete remission (CR1) (P<0.001) correlated with longer PFS. With a median follow-up of 10.3 years, 330 patients died. Ten-year overall survival (OS) from HDT was 52%. Shorter OS was associated on multivariate analysis with older age (P<0.001), chemoresistant disease (P<0.001), BM+PBPC as source of stem cells (P=0.007) and TBI-containing regimens (P=0.004). Thirty-nine patients developed secondary myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML), in 34 cases having received TBI as the conditioning regimen. The 5-year non-relapse mortality (NRM) was 9%. On multivariate analysis, older age (P<0.001), refractory disease (P<0.001) and TBI (P=0.04) were associated with a higher NRM. This long follow-up study shows a plateau in the PFS curve, suggesting that a selected group of patients might be cured with HDT. On the downside, TBI-containing regimens are associated with a negative impact on survival.
Montoto
S
S
Cancer Research UK Medical Oncology Unit, Institute of Cancer, Centre for Medical Oncology, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK. silvia.montoto@cancer.org.uk
Canals
C
C
Rohatiner
A Z S
AZ
Taghipour
G
G
Sureda
A
A
Schmitz
N
N
Gisselbrecht
C
C
Fouillard
L
L
Milpied
N
N
Haioun
C
C
Slavin
S
S
Conde
E
E
Fruchart
C
C
Ferrant
A
A
Leblond
V
V
Tilly
H
H
Lister
T A
TA
Goldstone
A H
AH
D000293:Adolescent; D000328:Adult; D001854:Bone Marrow Cells / Q000166:cytology; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D008224:Lymphoma, Follicular / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012074:Remission Induction; D013234:Stem Cells / Q000166:cytology; D014182:Transplantation, Autologous; D016896:Treatment Outcome