title: The impact of total body irradiation on the outcome of patients with follicular lymphoma treated with autologous stem-cell transplantation in the modern era: a retrospective study of the EBMT Lymphoma Working Party.
abstract: BACKGROUND
  The aim of this study was to investigate the impact of the high-dose regimen on the outcome of patients with follicular lymphoma (FL) having had autologous stem-cell transplantation (ASCT) in a recent time period.
  
  
  METHODS
  Between 1995 and 2007, 2233 patients with FL had their first ASCT with either a total body irradiation (TBI)-containing regimen or carmustin, etoposide, cytarabine and melphalan (BEAM), of which 47% were autografted in first remission.
  
  
  RESULTS
  After a median observation time of 73 months (interquartile range 30-107), 5- and 10-year non-relapse mortality (NRM) was similar (6% and 10% in both groups). No significant NRM differences became evident after multivariate adjustment for confounders. Secondary malignancies were observed in 9.7% and 7.9% of the patients after TBI and BEAM (P = 0.19), which were treatment-related myelodysplastic syndromes/acute myelogenous leukaemia (t-MDS/AML) in 3.4% and 2.8% (P = 0.57). The median time to t-MDS/AML was around 50 months in both groups. Because of a lower relapse incidence, TBI was associated with better event-free survival reaching statistical significance in the patients transplanted in first remission but not in those transplanted beyond first remission.
  
  
  CONCLUSIONS
  In patients with FL who received TBI-based ASCT after 1995 increased NRM and t-MDS/AML risks did not emerge compared with BEAM while disease control was at least equivalent.
authors.affiliation: Barts, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: El-Najjar
authors.affiliation: EBMT LWP Office, Paris.
authors.forename: A
authors.initials: A
authors.lastname: Boumendil
authors.affiliation: EBMT LWP Office, Paris.
authors.forename: J J
authors.initials: JJ
authors.lastname: Luan
authors.affiliation: Institute Paoli Calmettes, University de la Méditerranée, Marseille, France.
authors.forename: R
authors.initials: R
authors.lastname: Bouabdallah
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Thomson
authors.affiliation: INSERM, UMRs 938, Paris; Clinical Hematology and Cellular Therapy, Hospital Saint-Antoine, APHP, Paris; University Pierre et Marie Curie, Paris.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Hematology and Cellular Therapy, CHU Bretonneau, Tours.
authors.forename: P
authors.initials: P
authors.lastname: Colombat
authors.affiliation: Centre Leon Berard, Lyon.
authors.forename: P
authors.initials: P
authors.lastname: Biron
authors.affiliation: Department of Hematology, Centre Henri Becquerel, University of Rouen, Rouen.
authors.forename: H
authors.initials: H
authors.lastname: Tilly
authors.affiliation: Department of Internal Medicine I, Saarland University Medical School, Homburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Pfreundschuh
authors.affiliation: Department of Hematology, Henri Mondor University Hospital, Creteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Cordonnier
authors.affiliation: Department of Hematology, Addenbrooke's Hospital, Cambridge University, Cambridge, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.affiliation: Department of Hematology, University Hospital Grenoble.
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: APHP-Pitié Salpétrière, UPMC Universite Paris 6, Paris, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Vernant
authors.affiliation: Barts, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gribben
authors.affiliation: St James's Institute of Oncology, St James's University Hospital, Leeds.
authors.forename: G
authors.initials: G
authors.lastname: Cook
authors.affiliation: Nottingham University Hospital, Nottingham, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Haynes
authors.affiliation: Department of Hematology, University Hospital Saint-Luc, Catholic University Louvain, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Ferrant
authors.affiliation: EBMT LWP Office, Paris.
authors.forename: H
authors.initials: H
authors.lastname: Finel
authors.affiliation: Barts, London, UK; EBMT LWP Office, Paris.
authors.forename: S
authors.initials: S
authors.lastname: Montoto
authors.affiliation: EBMT LWP Office, Paris; Department of Medicine V, University of Heidelberg, Heidelberg, Germany. Electronic address: peter.dreger@med.uni-heidelberg.de.
authors.forename: P
authors.initials: P
authors.lastname: Dreger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011034:Podophyllotoxin / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D000069283:Rituximab; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine
keywords: follicular lymphoma; rituximab; secondary malignancies; t-MDS/AML; total body irradiation; transplantation