High-dose therapy with autologous stem-cell transplantation (ASCT) after first progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol

Background: Among the 566 patients with follicular lymphomas (FL) included in the GELF 86 prospective trials from October 1986 to September 1995, 372 with progressive/relapsing disease were analyzed retrospectively to identif y prognostic factors at first relapse. Patients and methods: For progressive FL, patients received mono- (22%) or polychemotherapy (78%) followed by high-dose therapy (HDT) with ASCT for 83 patients (22%). The median time to progression from initial treatment was 23 months (range 3-102 months) and 24% of documented patients (52 of 217) h ad histological transformation (HT). Salvage therapy produced an overall re sponse in 64% of patients and the five-year survival from progression was 4 2%. Results: For patients who underwent HDT with ASCT compared to standard trea tment, five-year freedom from second failure was at 42% vs. 16% (P = 0.0001 ) and five-year survival was 58% vs. 38% (P = 0.0005), respectively. The be nefit of HDT and ASCT remained if we consider only patients less than 65 ye ars (five-year survival at 60% vs. 40%; P = 0.001). Multivariate analysis o f parameters significant according to univariate analysis found that no ASC T at first progression, age at relapse > 50 years, progression on-therapy w ere adversely significant on survival. Conclusions: HDT with ASCT compared to standard treatment prolonged remissi on and survival after first progression of FL patients.