title: Prolonged clinical remissions in patients with relapsed or refractory follicular lymphoma treated with autologous stem cell transplantation incorporating rituximab.
abstract: Three sequential phase II trials were conducted with different immunotherapy approaches to enhance the outcome of autologous transplant (high-dose therapy and autologous stem cell transplantation (HDT/ASCT)) for recurrent follicular lymphoma. Seventy-three patients were enrolled from 1996 to 2009. Patients received HDT/ASCT combined with (1) interferon-α 3 MU/m(2) subcutaneously (SC) three times per week (TIW) for 2 years post-ASCT, (2) rituximab (R) 375 mg/m(2) for in vivo purging 3-5 days pre-stem cell collection and 2 × 4 weekly R at 2 and 6 months post-ASCT, respectively, or (3) three infusions of R pre-stem cell collection followed by 6× R weekly and interferon-α 3 MU/m(2) SC TIW. Although not statistically significant, progression-free survival (PFS) for patients who received rituximab was 56.4 and 49.1% at 5 and 10 years compared to 36 and 21% in those who did not receive rituximab. Molecular relapse post-HDT/ASCT was the strongest predictor of PFS in a multivariate analysis. Molecular relapse was coincident with or preceded clinical relapses in 84% of patients who relapsed—median of 12 months (range 0-129 months). Adverse events included secondary malignancy, transformation to diffuse large B cell lymphoma, prolonged mostly asymptomatic hypogammaglobulinemia, and pulmonary fibrosis. The long-term toxicity profile must be considered when selecting patients for this treatment.
authors.affiliation: Department of Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, neil.berinstein@oicr.on.ca.
authors.forename: N L
authors.initials: NL
authors.lastname: Berinstein
authors.forename: S
authors.initials: S
authors.lastname: Bhella
authors.forename: N M
authors.initials: NM
authors.lastname: Pennell
authors.forename: M C
authors.initials: MC
authors.lastname: Cheung
authors.forename: K R
authors.initials: KR
authors.lastname: Imrie
authors.forename: D E
authors.initials: DE
authors.lastname: Spaner
authors.forename: V
authors.initials: V
authors.lastname: Milliken
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: K
authors.initials: K
authors.lastname: Hewitt
authors.forename: A
authors.initials: A
authors.lastname: Boudreau
authors.forename: M D
authors.initials: MD
authors.lastname: Reis
authors.forename: A
authors.initials: A
authors.lastname: Chesney
authors.forename: D
authors.initials: D
authors.lastname: Good
authors.forename: Z
authors.initials: Z
authors.lastname: Ghorab
authors.forename: L K
authors.initials: LK
authors.lastname: Hicks
authors.forename: E
authors.initials: E
authors.lastname: Piliotis
authors.forename: R
authors.initials: R
authors.lastname: Buckstein
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality; D000069283:Rituximab; D014182:Transplantation, Autologous
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab