Myeloablative chemotherapy for chemo-sensitive recurrent follicular lymphoma: potential benefit in second relapse

Montoto, Silvia; Matthews, Janet; Greaves, Paul; Lillington, Debra M.; Anderson, Deborah; Gribben, John G.; Lister, T. Andrew

doi:10.3324/haematol.2012.069583

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…A further recent study reviewing BEAM ASCT in patients with FL has grouped lines of treatment together slightly differently and shown no significant difference in outcome in patients who have received three or more lines of treatment, when compared to those who have received two or less (Montoto et al , ). When we grouped and analysed our patients in the same way, our data was in accord with this (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure

et al. 2014

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SummaryThe role of autologous stem cell transplantation (ASCT) and the optimal timing of such transplants in patients with follicular lymphoma (FL) remains contentious. We present a single-centre experience documenting the outcomes of 70 FL patients who underwent BEAM (carmustine, cytarabine, etopside, melphalan)-conditioned ASCT between 1988 and 2009. With a median follow-up of 6Á8 years (0Á1-19Á2), the 7-year overall survival (OS) and progression-free survival (PFS) from the date of ASCT was 76% and 60%, respectively. A significant difference in OS was found when comparing the patients transplanted in first or second remission versus those transplanted in later remissions (P = 0Á02) and this significance was maintained when OS was calculated from the date of diagnosis (P = 0Á03). There was a plateau on the PFS curves for patients transplanted in either first or second remissions after 9Á3 and 6Á4 years respectively, suggesting that these groups may never relapse. No differences were seen in OS or PFS in those treated with rituximab prior to transplant versus those who were not. Our data shows that BEAM ASCT can be a highly effective treatment in patients with FL early in the disease course, and that a proportion of patients experience prolonged disease-free survival and may be cured.

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Section: Discussionmentioning

confidence: 99%

Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure

et al. 2014

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“…51 ASCT, however, retains its role as a therapeutic option in the relapse setting where long-lasting remissions can be achieved. [52][53][54][55][56] Whether and when ASCT should be applied, that is, at first, second or third relapse, is not defined and must currently remain an individual's decision, which may be based on the patient's age and general condition, type and intensity of prior therapy and actual lymphoma manifestations including risk factors such as bulky disease, extranodal involvement, lactate dehydrogenase and beta-2-microglobulin levels.…”

Section: Therapy Of Fls At Advanced Stages III and Ivmentioning

confidence: 99%

How we manage follicular lymphoma

Hiddemann

Cheson

2014

Leukemia

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Major changes have taken place within the last few years in the management of follicular lymphoma (FL) leading to substantial improvement in prognosis and overall survival. For some patients with limited disease stages I and II, radiotherapy may be associated with durable responses; however, it is unclear whether patients are cured and new approaches such as the combination of irradiation with rituximab or even single-agent rituximab need to be explored. Whereas watch and wait is the current standard for stage III and IV disease with low tumour burden, better indices are warranted to potentially select patients for whom early intervention is preferred. For advanced stages with a high tumour burden, immunochemotherapy followed by 2 years of rituximab maintenance is widely accepted as standard therapy, although re-treatment at recurrence may be an alternative option. Highly attractive new therapeutic options have recently arisen from new antibodies, and from new agents targeting oncogenic pathways such as B-cell receptor signalling pathways or inhibition of bcl 2. Furthermore, immunomodulatory drugs may add to the therapeutic armamentarium and may lead to 'chemotherapy-free' therapies in the near future. Hence, the management of FLs has become a moving target and the hope is justified that the long-term perspectives of patients suffering from the disease will be further improved in the near future.

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“…6 High-dose salvage regimens, including chemotherapy, rituximab and/or TBI, followed by autologous hematopoietic cell transplantation (HCT) have also clearly improved 5-year PFS and OS. [7][8][9] More recently, the type II CD20-Ab obinutuzumab, 10,11 bortezomib, 12 lenalidomide, 13 idelalisib, 14 ibrutinib, 15 bcl-2 inhibitors 16 and Car T cells 17 have potential for further refinement of the clinical outcome in FL patients. However, despite all recent innovative approaches, cure of FL cannot yet be achieved.…”

Section: Introductionmentioning

confidence: 99%

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Heinzelmann

Bethge²,

Beelen

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry 'DRST'. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2-and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽ 42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatmentsensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾ 55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽ 42 years should be preferred if available.

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Myeloablative chemotherapy for chemo-sensitive recurrent follicular lymphoma: potential benefit in second relapse

Abstract: ABSTRACTreceive immunochemotherapy as first-line treatment are presenting with disease progression.

Cited by 12 publications

References 26 publications

Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure

Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure

How we manage follicular lymphoma

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

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