High-Dose Therapy and Autologous Stem-Cell Support for Chemosensitive Transformed Low-Grade Follicular Non-Hodgkin’s Lymphoma: A Case-Matched Study From the European Bone Marrow Transplant Registry

Abstract

Patients with chemosensitive transformed lymphoma should be seriously considered for high-dose therapy and autologous stem-cell support.

Transformed lymphoma: an Achilles' heel of non-Hodgkin's lymphoma

“…51 With a median follow-up of 63 months, the transplant group had an OS of 53% and 5 year event-free survival of 46%. Again, these results are comparable to outcomes for transformed lymphoma and the case-matched comparisons performed by Williams et al 6 As noted above, some studies incorporated purging of stem cells with monoclonal antibodies in hopes of removing all malignant cells. It remains unclear whether or not purging improves outcomes.…”

“…[4][5][6][7][8] It is difficult to determine the true incidence as it depends not only on the definition of HT, but also on the frequency and sites of biopsy, duration of follow-up, and the population considered at risk. Optimally, a change in the clinical nature of disease leads to a repeat lymph node biopsy that reveals a progression from follicular to diffuse histology of a higher grade.…”

“…However, cases of HT have been reported more than 10 years from diagnosis, suggesting an increased risk of HT with time and number of relapses. [4][5][6][7] Another method to quantify the incidence of HT is with autopsy data. Garvin et al 8 classified histology at autopsy of 192 cases and compared it to that at initial diagnosis.…”

“…Early studies proposed chemotherapy and radiation as potential factors in transformation. 6,8,[25][26][27] Arguing against the contribution of chemotherapy drugs to HT is Horning's data that showed similar rates of trans-formation for treated and initially untreated follicular lymphoma. 9 …”

Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma

“…11,12,16,19,20 Only one study of 50 patients with transformed disease demonstrated no difference in outcomes indirectly, comparing the patients to historical controls with de novo follicular or de novo large cell lymphoma. 21 In our cohort of 49 patients, among whom 22 had transformed disease, histologic transformation was not a statistically significant predictor of OS or EFS by multivariable analysis. Furthermore, complete response after ASCT and age younger than 60 years remained the best predictors of EFS and OS in this subgroup.…”