Long-term follow-up of high-dose treatment with autologous haematopoietic progenitor cell support in 693 patients with follicular lymphoma: an EBMT registry study

Abstract

To evaluate the outcome of a large series of patients who received high-dose treatment (HDT) for follicular lymphoma (FL), 693 patients undergoing HDT (total-body irradiation (TBI)-containing regimen: 58%; autologous bone marrow (BM)/peripheral blood progenitor cells (PBPCs): 378/285 patients) were included in the study. A total of 375 patients (54%) developed recurrent lymphoma, 10-year progression-free survival (PFS) being 31%. On multivariate analysis, younger age (P=0.003) and HDT in first complete remission (CR1) (P<0.001) correlated with longer PFS. With a median follow-up of 10.3 years, 330 patients died. Ten-year overall survival (OS) from HDT was 52%. Shorter OS was associated on multivariate analysis with older age (P<0.001), chemoresistant disease (P<0.001), BM+PBPC as source of stem cells (P=0.007) and TBI-containing regimens (P=0.004). Thirty-nine patients developed secondary myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML), in 34 cases having received TBI as the conditioning regimen. The 5-year non-relapse mortality (NRM) was 9%. On multivariate analysis, older age (P<0.001), refractory disease (P<0.001) and TBI (P=0.04) were associated with a higher NRM. This long follow-up study shows a plateau in the PFS curve, suggesting that a selected group of patients might be cured with HDT. On the downside, TBI-containing regimens are associated with a negative impact on survival.

The outcome of reduced intensity allogeneic stem cell transplantation and autologous stem cell transplantation when performed as a first transplant strategy in relapsed follicular lymphoma: an analysis from the Lymphoma Working Party of the EBMT

“…Thus following an auto-SCT the development of secondary MDS (myelodysplastic syndrome)/AML has been reported in up to 10% of patients at 10 years post transplant. 2,4,5,21 The follow-up period of the current study was too short to identify all cases of secondary MDS/AML in the auto-SCT cohort and additional cases would be expected to occur with longer follow-up, thus negatively impacting on the outcome of this group. Conversely, GVHD remains a significant problem following a RIST with 50% of patients in this study developing cGVHD.…”

“…[11][12][13][14][15] By contrast, auto-SCT is associated with a low early NRM of o5%. 2,3,[18][19][20] Late toxicities must also be taken into consideration when selecting a transplant strategy. Thus following an auto-SCT the development of secondary MDS (myelodysplastic syndrome)/AML has been reported in up to 10% of patients at 10 years post transplant.…”

“…1 Auto-SCT is associated with acceptable toxicity and a low TRM, and long-term follow-up studies suggest that a significant minority of patients may be cured with these procedures. 2,3 However, there are concerns about both late relapses and the development of secondary leukaemia following auto-SCT. [2][3][4][5] Myeloablative therapy and allo-SCT has been employed in patients with advanced FL and is capable of inducing lasting remissions and cure even in patients with advanced disease.…”

“…2,3 However, there are concerns about both late relapses and the development of secondary leukaemia following auto-SCT. [2][3][4][5] Myeloablative therapy and allo-SCT has been employed in patients with advanced FL and is capable of inducing lasting remissions and cure even in patients with advanced disease. [6][7][8] However, this therapeutic modality has been limited in its application due to the high TRM and is generally reserved for younger patients.…”

Preferences of patients and physicians concerning treatment options for relapsed follicular lymphoma: a discrete choice experiment

“…As opposed to the lack of published longterm data related to allo-SCT, long-term results beyond 10 years following auto-SCT report plateaus on PFS curves for studies specifically addressing follicular lymphoma patients transplanted prior to third or later relapse. 13,[26][27][28] Therefore, issue of 'cure' for follicular lymphoma is controversial, and dramatically increasing the number of required scenarios by adding another attribute to the questionnaire was considered to be unjustified. A 5-year period of PFS was considered to be a reasonable measure of treatment effectiveness for the purpose of this study.…”