title: The impact of histologic grade on the outcome of high-dose therapy and autologous stem cell transplantation for follicular lymphoma.
abstract: The impact of the follicular lymphoma (FL) histologic grade on outcomes after high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) is unknown. We evaluated 219 consecutive patients with grades 1-3 FL who underwent HDT and ASCT at our center. Overall survival (OS), progression-free survival (PFS), relapse and non-relapse mortality (NRM) was estimated for each grade after controlling for other predictive factors. The number of patients with grades 1, 2 and 3 FL was 106 (48%), 75 (34%) and 38 (17%), respectively. Five-year outcome estimates for the entire cohort included 60% OS, 39% PFS and 46% relapse (median follow-up=7.8 years). PFS and relapse were nearly identical among patients with grade 3 FL versus grades 1-2 FL after adjusting for other contributing factors (hazard ratio (HR)=0.90, P=0.68; HR=1.07, P=0.80, respectively). The hazard for mortality (HR=0.70, P=0.23) and NRM (HR=0.33, P=0.07) was non-significantly lower among patients with grade 3 FL compared to patients with grades 1-2 disease. Factors associated with inferior PFS included elevated lactate dehydrogenase (HR=1.52, P=0.03), chemoresistance (HR=1.82, P=0.02), > or =2 prior therapies (HR=1.8, P=0.03) and prior radiation (HR=1.99, P=0.003). These data suggest that the histologic grade of FL does not impact PFS or relapse following HDT and ASCT.
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Pham
authors.forename: T A
authors.initials: TA
authors.lastname: Gooley
authors.forename: G E
authors.initials: GE
authors.lastname: Keeney
authors.forename: O W
authors.initials: OW
authors.lastname: Press
authors.forename: J M
authors.initials: JM
authors.lastname: Pagel
authors.forename: H A
authors.initials: HA
authors.lastname: Greisman
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: L A
authors.initials: LA
authors.lastname: Holmberg
authors.forename: S H
authors.initials: SH
authors.lastname: Petersdorf
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
authors.forename: A K
authors.initials: AK
authors.lastname: Gopal
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents