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Prolonged PFS after Autologous Stem Cell Transplantation in Follicular Lymphoma Patients: A Long-Term Retrospective Study.

2008; Elsevier BV; Volume: 112; Issue: 11 Linguagem: Inglês

10.1182/blood.v112.11.2190.2190

1528-0020

Violaine Safar, Thomas Gastinne, Nöel Milpied, Hervé Maisonneuve, Nadine Morineau, Viviane Dubruille, Beatrice Mahé, Philippe Moreau, Henri Jardel, Lucie Planche, Philippe Moreau, Jean‐Luc Harousseau, Steven Le Gouill,

Chronic Myeloid Leukemia Treatments

Abstract Background: The course of follicular lymphoma (FL) is characterized by iterative relapses. Several reports have demonstrated that intensive chemotherapy followed by autologous stem cell transplantation (auto-SCT) is an attractive treatment. Because a subgroup of patients obtains prolonged complete remission after auto-SCT, some authors have postulated that auto-SCT may cure FL patients. In order to address this issue and to characterize long-term responders, we retrospectively studied the outcome of 80 FL patients who underwent auto-SCT in our institution. Patients characteristics: Between 1989 and 2004, 80 FL patients underwent auto-SCT in the Haematology Department of Nantes Medical University, France. All patients had a FL according to the WHO classification. Median age at diagnosis was 45.7 (range 27–62) and median age at the time of transplantation was 48.1 (range 27–69). Auto-SCT was performed upfront in 36 cases, at first relapse in 36 cases and at a subsequent relapse in 8 cases. Median time from diagnosis to auto-SCT was 53 months. At diagnosis, 25 patients presented with a FLIPI <2 and ≥ 2 in 34 cases (data missing =21). Prior to auto-SCT, 71 patients received a CHOP or CHOP-like regimen and 24 patients received a cytarabine-containing regimen. The conditioning regimens prior auto-SCT were TBI-cyclophosphamide (63 patients) or BEAM (17 patients). The source of stem cell was either bone marrow (19 patients) or peripheral blood stem cell (59 patients); 2 patients received both. In note, the graft was purged using a CD34+ selection in 30 cases or a B-depletion in 19 cases. In the course of their disease (prior or after transplantation), 35 patients received Rituximab. Results: Median follow-up (calculated from the time of auto-SCT) was 6.2 years (range 0.2–16.6) (data missing =1). No patient died during the auto-SCT procedure. After auto-SCT, 71 patients reached CR/CRu. Thirty-five patients relapsed and 10 patients experienced histological transformation (HT)(including 8 cases with HT at first relapse). Myelodysplasia/AML occurred in 5 cases. At the time of the analysis, 68 patients were still alive. Causes of death were: HT in 6 cases, AML in 3 cases, follicular lymphoma related in 2 cases and not related to lymphoma in one case. The 3-, 5- and 7-year progression free survival (PFS) estimates were 74.7%, 66.5% and 58.6%, respectively. In note, a plateau occurred on the PFS Kaplan-Meier curve after 8 years. The 3-, 5- and 7-year overall survival (OS) estimates were 92.9%, 86% and 79.7%, respectively. In univariate analysis, five variables (age at the time of auto-SCT < 50y, a purged graft, a Rituximab-containing therapy, an extra-nodal excluding bone marrow involvement at diagnosis and FLIPI <2 ) were found to be statistically significant at a p<0.15 level and were included in the multivariate analysis. In multivariate analysis, the PFS was significantly better for patients with a FLIPI<2 (p=0.043) and patients<50 years at the time of auto-SCT (p=0.03). A trend for a better PFS was observed for patients who received Rituximab in the course of the disease (p= 0.084). Conclusion: By multivariate analysis, we demonstrate that the FLIPI is a strong predictive index to predict PFS after auto-SCT. Moreover, our results confirm the major interest of auto-SCT in the treatment of FL and highlight that the opportunity to perform auto-SCT should not be jeopardize during the course of the disease. Finally, the plateau on the PFS curve suggests that some FL patients could be cured by auto-STC.