Jm. Foran et al., HIGH-DOSE THERAPY WITH AUTOLOGOUS HEMATOPOIETIC SUPPORT IN PATIENTS WITH TRANSFORMED FOLLICULAR LYMPHOMA - A STUDY OF 27 PATIENTS FROM A SINGLE-CENTER, Annals of oncology, 9(8), 1998, pp. 865-869
Background: The prognosis of patients with transformed follicular lymp
homa (FL-t) is poor. The use of high-dose therapy (HDT) with autologou
s haematopoietic support was therefore evaluated as consolidation of r
emission. Patients and methods: Twenty-seven patients received high-do
se cyclophosphamide and total body irradiation (cyclo + TBI) with auto
logous bone marrow (BM; n = 24) or peripheral blood progenitor cell su
pport (PBPC; n = 3). BM was treated in vitro with anti-B cell antibodi
es and complement. Nineteen of 27 patients were treated in first stabl
e remission following transformation. Eight other patients with a hist
ory of transformation were treated following a subsequent recurrence o
f follicular lymphoma (FL). Results: With a median follow-up of 2.4 ye
ars, 14 of 27 patients remain alive and in remission; five are alive a
nd free of disease at more than four years. The median survival is 8.5
years. There were two 'early' treatment-related deaths of respiratory
failure, and two 'late' deaths of myelodysplastic syndrome (MDS) in r
emission of lymphoma at 2.8 and 8.5 years. Seven of nine patients havi
ng had a recurrence underwent re-biopsy. In two, histology revealed FL
, in five, transformed follicular lymphoma. One of the patients with r
ecurrent FL is alive without further therapy, and two of five patients
with recurrent FL-t are alive and in remission after further chemothe
rapy.Conclusions: It is appropriate to consider HDT for younger patien
ts with FL-t in remission. Repeat biopsy should be considered for pati
ents with recurrent disease. There is a risk of late MDS In patients u
ndergoing this treatment.