Long‐term outcome in patients with follicular lymphoma following high‐dose therapy and autologous stem cell transplantation

Abstract

Objective To contribute data on long‐term outcome and potential curative impact of ASCT in FL, especially following HDT with the BEAM protocol (BCNU, etoposide, cytarabine and melphalan), given very limited data on this topic in the literature. Patients and methods Patients with FL (n = 76) were treated in our institution with HDT and ASCT. In the case of long‐term remission (≥8 years), peripheral blood was tested for minimal residual disease by t(14;18)‐ and IGH‐PCR, including the last follow‐up. Results 10‐year overall survival, progression‐free survival, and freedom from progression (FFP) after first‐line ASCT (n = 20) were 80%, 60%, and 69%, after second‐line ASCT (n = 48, following BEAM) 66%, 38%, and 41%, after third/fourth‐line ASCT (n = 8) 33%, 25%, and 25%, respectively. Prognostic factors for FFP were treatment line and FLIPI (Follicular Lymphoma International Prognostic Index). 10‐year FFP for second‐line ASCT and low‐risk FLIPI at relapse was 69%, intermediate‐risk 28%, and high‐risk 25% (P < .05). 26 patients developed sustained long‐term clinical and molecular remissions of up to 27 years. Conclusions Sustained long‐term clinical and molecular complete remissions up to 27 years can be achieved following ASCT (including HDT with BEAM in second treatment line), indicating a potential curative impact of ASCT in FL.

Long‐term follow‐up demonstrates curative potential of autologous stem cell transplantation for relapsed follicular lymphoma

“…This is one of the largest studies published to date evaluating the long‐term outcomes of ASCT for relapsed FL. The results of our analysis are consistent with previous prospective and retrospective studies that reported 8‐to‐12‐year PFS rates of 30%–60% after ASCT 16–25 . Taken together, these data challenge the notion that FL is an incurable lymphoma and provide compelling evidence that ASCT should be considered a valuable, potentially curative option for eligible patients with this disease.…”

“…The results of our analysis are consistent with previous prospective and retrospective studies that reported 8-to-12-year PFS rates of 30%-60% after ASCT. [16][17][18][19][20][21][22][23][24][25] Taken together, these data challenge the notion that FL is an incurable lymphoma and provide compelling evidence that ASCT should be considered a valuable, potentially curative option for eligible patients with this disease. The only randomized trial of ASCT in relapsed FL was the European CUP trial, which found that ASCT resulted in superior PFS (55%-58% vs. 26%) and OS (71%-77% vs. 46%) compared to conventional chemotherapy.…”

A retrospective study of treatment and outcomes of patients with lymphoma undergoing hematopoietic stem cell transplantation

“…It is thought that the length of hospital stay is long because the SCT process is a di cult treatment option and patients experience various symptoms related to transplantation. It was determined that chemotherapy and the BEAM protocol were often applied in SCT [14,19,20], and that prolonged hospitalization times were observed [21]. The reason for examining the treatments was to increase the awareness of nurses applying chemotherapy protocols about patients with lymphoma undergoing SCT.…”

“…Therefore, it is essential for nurses working in SCT units to follow up on the treatment and outcomes of patients with lymphoma frequently [8,13]. HSCT is among the treatment approaches that prolong the life of patients with lymphoma, improve their quality of life, achieve remission success and reduce the incidence of relapse [11,14]. Although SCT contributes positively to the recovery process of patients with lymphoma, it causes patients to face many social, economic, and psychological problems [15,16].…”

Age and lymphocyte/monocyte ratio as prognostic factors for autologous transplantation in the treatment of patients with follicular lymphoma

“…Several trials have discussed the importance of ASCT in relapsing FL; large prospective trials have shown that the use of ASCT is no longer supported in first remission because of the absence of an OS benefit despite improvement in progressionfree survival (PFS). [2][3][4][5] High-dose chemotherapy (HDT) followed by ASCT in second remission appears to be the best strategy for timing ASCT. The advantage is greater than total-body irradiation-free conditioning (e.g., rituximab plus bis-chloroethylnitrosourea, carmustine [BCNU]) in younger patients with chemosensitive disease because the use of total-body irradiation conditioning appears to increase the risk of secondary malignancies such as acute myeloid leukemia/myelodysplastic syndrome.…”