title: Durable event-free survival following autologous stem cell transplant for relapsed or refractory follicular lymphoma: positive impact of recent rituximab exposure and low-risk Follicular Lymphoma International Prognostic Index score.
abstract: Published studies have provided conflicting results regarding the curative potential of high dose chemotherapy and autologous stem cell transplant (HDT/ASCT) for follicular lymphoma (FL). Our objectives were to evaluate the long-term event-free (EFS) and overall (OS) survival rates following ASCT for FL, and to identify predictors of improved outcome. We conducted a retrospective analysis of the first 100 consecutive patients with relapsed or refractory FL treated with HDT/ASCT in Calgary from 1993 to 2008. With a median follow-up of 65 months (range 16-178) post-ASCT, 5-year EFS and OS rates were 56% (95% confidence interval [CI] 46-66%) and 70% (95% CI 61-79%), respectively. A plateau on the EFS curve is evident starting 6 years post-ASCT. Also, the EFS post-ASCT was markedly longer than the 12-month median EFS from last therapy prior to ASCT (p < 0.0001). Failure of rituximab pre-ASCT was not associated with EFS or OS. Severe toxicities included two early treatment-related deaths, and four late deaths from secondary leukemia. Independent predictors of EFS and OS in multivariate analysis were rituximab therapy within 6 months of ASCT, chemosensitivity and FLIPI (FL International Prognostic Index) score 0-1. In conclusion, our data suggest that over 50% of patients with relapsed/refractory FL who have failed 1-2 prior chemotherapy regimens achieve long-term EFS following HDT/ASCT.
authors: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Anthea C
authors: AC
authors: Peters
authors: Qiuli
authors: Q
authors: Duan
authors: James A
authors: JA
authors: Russell
authors: Peter
authors: P
authors: Duggan
authors: Carolyn
authors: C
authors: Owen
authors: Douglas A
authors: DA
authors: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D007391:International Cooperation; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000209:etiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab