Autotransplants for histologically transformed follicular non-Hodgkin's lymphoma

Histological transformation from a follicular non-Hodgkin's lymphoma (NHL) to a higher grade lymphoma carries a poor prognosis despite treatment with aggressive anthracycline-based chemotherapy, We retrospectively analysed 35 patients with histologically transformed NHL who underwent high-dose thera py and autotransplantation at our centre, Patients up to 65 years old were eligible for autotransplant at the time of transformation or with subsequen t relapses, provided that chemosensitivity to a salvage regimen could be de monstrated. All patients received high-dose therapy [etoposide 60 mg/kg, me lphalan 160 mg/m(2) and fractionated total body irradiation (TBI) 12 Gy] fo llowed by unpurged autologous bone marrow or blood stem cell rescue. Most p atients (69%) had advanced stage disease (stages 3-4) at transformation and bone marrow involvement was common (49%). Twenty-six (74%) patients were i n partial remission (PR) and nine (26%) in complete remission (CR) at the t ime of transplant. Median duration from transformation to transplant was 10 .9 months (range, 5.2 months-4.6 years), At a median follow up of 52 months after autotransplant, 19 (54%) patients had died. Causes of death were pro gressive lymphoma in nine patients (26%), treatment-related mortality (TRM) in seven (20%) and myelodysplasia in three (8%), Only five patients in our cohort were > 60 years old, but all died as a result of treatment-related causes (mostly pulmonary infections). Five-year overall survival and progre ssion-free survival from time of transplant were 37% and 36% respectively. Using multivariate analysis of factors including gender, age, stage, extran odal disease, disease bulk. B symptoms, number of prior therapies, relapse status and CR/PR status at transplant, only advanced age significantly pred icted for survival from autotransplant (P = 0.002). Our survival data are c omparable to previous reports of autotransplantation for transformed NHL an d suggest a benefit over standard chemotherapy alone in selected patients. However, our high TRM cautions the use of aggressive therapy, including TBI , in patients over 60 years old.