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Biol Blood Marrow Transplant. 2017 Oct;23(10):1631-1640. doi: 10.1016/j.bbmt.2017.05.021. Epub 2017 May 19.

Autologous Stem Cell Transplantation for Follicular Lymphoma: Favorable Long-Term Survival Irrespective of Pretransplantation Rituximab Exposure.

Author information

1
Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: anitiju@hotmail.com.
2
Hospital Universitario 12 de Octubre, Madrid, Spain.
3
Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.
4
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
5
Hospital Universitario Sant Pau, Barcelona, Spain.
6
Hospital Universitario de Canarias, Tenerife, Spain.
7
Hospital Universitario de Jerez, Jerez, Spain.
8
Hospital Universitario La Princesa, Madrid, Spain.
9
Hospital Universitario Donostia-Aránzazu, San Sebastián, Spain.
10
Hospital Universitario Vall de Hebrón, Barcelona, Spain.
11
Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Spain.
12
Hospital Universitario A Coruña, A Coruña, Spain.
13
Hospital Universitario Ramón y Cajal, Madrid, Spain.
14
Hospital Universitario Virgen de la Arriaxaca, Murcia, Spain.
15
Hospital Central de Asturias, Asturias, Spain.
16
Hospital Universitario de Vigo, Vigo, Spain.
17
Hospital Universitario Morales de Messeguer, Murcia, Spain.
18
Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain.
19
Hospital Clinic de Barcelona, Barcelona, Spain.
20
Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
21
Hospital Universitario la Fe, Valencia, Spain.
22
Hospital Clínico San Carlos, Madrid, Spain.
23
Hospital del Mar, Barcelona, Spain.

Abstract

High-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) has contributed to modify the natural history of follicular lymphoma (FL); however, an overall survival (OS) benefit has been demonstrated at relapse only after a rituximab-free chemotherapy regimen. A total of 655 patients with FL were reported to the Spanish GELTAMO (Grupo Español de Linfomas y Trasplantes de Médula Ósea) registry and underwent first ASCT between 1989 and 2007. A total of 203 patients underwent ASCT in first complete response (CR1), 174 in second complete response (CR2), 28 in third complete response (CR3), 140 in first partial response (PR1), 81 in subsequent PR, and 29 with resistant/refractory disease; 184 patients received rituximab before ASCT. With a median follow-up of 12 years from ASCT, median progression-free survival (PFS) and overall survival (OS) were 9.7 and 21.3 years, respectively. Actuarial 12-year PFS and OS were 63% (95% confidence interval [CI], 58%-68%) and 73% (95% CI, 68%-78%), respectively, for patients in CR (with a plateau in the curve beyond 15.9 years), 25% (95% CI, 19%-28%) and 49% (95% CI 42%-56%), respectively, for patients in PR, and 23% (95% CI, 8%-48%) and 28% (95% CI, 9%-45%), respectively, for patients with resistant/refractory disease (P < .001). In patients who received rituximab before ASCT, the estimated 9-year PFS and OS from ASCT were 59.5% (95% CI, 51%-67%) and 75% (95% CI, 68%-83%), respectively. Interestingly, for patients who underwent transplantation in CR ≥2 or PR ≥2 who had received rituximab before ASCT (n = 90), 9-year PFS and OS were 61% (95% CI, 51%-73%) and 75% (95% CI, 65%-80%), respectively, with no relapses occurring beyond 5.1 years after ASCT. The cumulative incidence of second malignancies in the global series was 6.7% at 5 years and 12.8% at 10 years. This analysis strongly suggests that ASCT is a potentially curative option for eligible patients with FL. In the setting of relapse, it is of especial interest in pretransplantation rituximab-sensitive patients with FL.

KEYWORDS:

Autologous stem cell; Follicular lymphoma; Long-term follow-up; Rituximab; Trasplantation

PMID:
28533060
DOI:
10.1016/j.bbmt.2017.05.021
[Indexed for MEDLINE]
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