Autologous stem cell transplantation in advanced follicular lymphoma. A single center experience

Background and Objective. The use of intensive therapy supported by autolog ous stem cell transplantation (ASCT) is being investigated as treatment for poor-prognosis follicular lymphomas (FL). A single-center experience is he rein reported. Design and Methods. From September 1990 to October 1997, 30 consecutive pat ients (pts) with advanced FL received transplants, 8 of bone marrow and 22 of peripheral blood, thirteen harvests were purged by an immunomagnetic met hod using anti-B antibodies. Twenty-seven patients received salvage chemoth erapy (CT) before ASCT with the objective of reaching this procedure in the best possible response. The disease status at ASCT was: 1(st) CR In 7 pts, greater than or equal to 2(nd) CR in 6 pts, PR in 10 pts, untreated relaps e in 2 pts and chemoresistant disease in 5 pts. Results. There was only one transplant-related death (one month after ASTC) . With a median follow-up of 19 (1-89) months, 27 pts are alive, 8 pts have relapsed/progressed at a median time of 11 (6-22) months after ASCT. The e stimated 2-year PFS and OS am 57% (95% CI, 34-81%) and 83% (95% CI, 64 -100 %). When comparing the progression-free interval (PFI) before salvage CT an d ASCT acid the PFI after ASCT, of 17 evaluable pts, 10 had a PFI after ASC T longer than the previous interval, and 5 additional pts remain in CR/PR w ith a follow-up that has not yet reached the duration of pre-transplant res ponse. By contrast, 2 pts had a short post-transplant response. Interpretation and Conclusions, High-dose therapy followed by ASGT obtains a high rate of responses, frequently longer than any previous PFI. Addition al follow-up is necessary to determine whether there is any "plateau" in re sponse duration and to define what proportion of pts may be cured with ASCT in this setting. (C) 1999, Ferrata Storti Foundation.