Prognostic factors for the clinical outcome of patients with follicular lymphoma following high-dose therapy and peripheral blood stem cell transplantation (PBSCT)

This is a report on 111 patients with advanced stage follicular lymphoma wh o where autografted using PBSC. Seventy patients were enrolled in first rem ission, whereas 41 were treated in second or higher remission. High-dose th erapy consisted of total body irradiation plus cyclophosphamide in 103 pati ents, while eight patients received BEAM (carmustine, etoposide, cytosine-a rabinoside, melphalan). Autografts contained 8.1 +/- 0.6 x 10(6) CD34(+) ce lls/kg body weight. At a median follow-up of 44.2 months from PBSCT (range 4.9-77.4 months), 93 patients are alive, with a probability of overall and relapse-free survival (RFS) of 83% and 64%, respectively. A significantly h igher probability of relapse was associated with male gender, involvement o f more than eight lymph node areas, extra-nodal manifestations other than b one marrow and PBSCT performed in second or higher remission. In the latter group of patients, previous radiotherapy was associated with poor prognosi s. The relevance of chemosensitivity as a prognostic factor was reflected b y a better RFS in patients who had achieved complete remission at the time of PBSC mobilization. In a multivariate analysis, involvement of eight or m ore lymph nodes and high-dose therapy performed in second or higher remissi on were independent prognostic factors.