Autologous stem cell transplantation with in vivo purged progenitor cells shows long‐term efficacy in relapsed/refractory follicular lymphoma

Abstract

High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been shown effective in the control of relapsed/refractory follicular lymphoma. We evaluate the long-term outcome of patients with relapsed or refractory follicular lymphoma treated with ASCT with in vivo purged progenitors cells. We report the long-term results of a prospective multicenter phase 2 trial on 124 relapsed/refractory follicular lymphoma patients treated with a program of anthracycline-based debulking chemotherapy, immunochemotherapy, mobilization of in vivo purged PBSC followed by ASCT. Median age was 52 years; 14% of patients had grade 3A histology. Debulking chemotherapy produced CR in 16% and PR in 71%, while 13% of patients progressed. After rituximab, cyclophosphamide, vincristine, prednisone (R-COP), CR was obtained in 60% and PR in 35%; 118 patients successfully mobilized PBSC and 117 proceeded to ASCT. The harvest in all the 32 molecularly informative patients was bcl-2 negative. TRM was 0%. The 5-year PFS was 54% and the 5-year OS was 83%. After a median f-up of 6.7 years (range 1.5-13.6), 54% are still in CR. These data show that prolonged PFS is achievable in relapsed/refractory patients with high dose autologous transplantation of in vivo purged progenitor cells.

Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and High-Dose Rituximab for Allogeneic Hematopoietic Cell Transplantation for Follicular Lymphoma: A Phase Two Multicenter Trial from the Blood and Marrow Transplant Clinical Trials Network

“…While there has only been one prospective trial comparing autoHCT with RIC alloHCT for relapsed FL patients, this study closed prematurely due to poor accrual 16 . Retrospective and prospective studies with autologous HCT have yielded 5 year PFS ranging from 40%-60% 6, 7, 15, 36, 37 . Retrospective comparisons of autologous and allogeneic HCT for relapsed/refractory FL include a report from the National Comprehensive Cancer Network (NCCN) comparing the outcomes of 135 FL patients who received an autologous HCT to 49 patients who underwent either myeloablative or RIC allogeneic HCT 5 .…”

Minimal residual disease in non‐Hodgkin lymphoma – current applications and future directions

“…Some patients with FL undergo treatment with chemotherapy followed by ASCT. This regimen is usually reserved for patients with relapsed/refractory disease, given that its use as first line therapy has not been shown to increase OS, unlike in relapsed or refractory disease (Schouten et al , ; Al Khabori et al , ; Arcaini et al , ). While no data exist at present, the rigorous testing of MRD in the pre‐ASCT setting and even in the stem cell product (as in DLBCL) could potentially allow the optimal targeting of ASCT to patients most likely to benefit.…”