HIGH-DOSE THERAPY WITH AUTOLOGOUS HEMATOPOIETIC SUPPORT IN PATIENTS WITH TRANSFORMED FOLLICULAR LYMPHOMA - A STUDY OF 27 PATIENTS FROM A SINGLE-CENTER

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.