B. Seyfarth et al., Autologous stem cell transplantation for follicular lymphoma: no benefit for early transplant?, ANN HEMATOL, 80(7), 2001, pp. 398-405
Autologous stem cell transplantation (SCT) is widely used as salvage treatm
ent for patients with relapsed follicular lymphoma (FL). Although SCT can i
nduce prolonged remissions, it does not appear to be curative in the vast m
ajority of patients. The purpose of this study was to investigate if incorp
oration of SCT into first-line therapy can improve its efficacy. Fifty-five
patients underwent sequential high-dose therapy as up-front (n=33) or salv
age treatment (n=22) for advanced stage FL at our institution. Treatment co
nsisted of intensive chemotherapy with dexamethasone, carmustine (BCNU), et
oposide, cytarabine, and melphalan (Dexa-BEAM) for mobilization of peripher
al stem cells and reduction of tumor load, followed by one of three differe
nt myeloablative regimens and SCT. With a median followup of 4 years, proje
cted event-free survival (EFS) and overall survival (OS) at 4 years post tr
ansplant was 59% and 84%, respectively, with no evidence of plateau in the
survival curves. By univariate and multivariate analysis weighing age, sex,
stage, BM and extranodal involvement, timing of transplant, ex vivo purgin
g, and conditioning regimen [total body irradiation (TBI) vs non-TBI], the
only significant factor predicting for superior Zn EFS and OS was up-front
vs salvage transplant (4-year EFS 76% vs 38%, p=0.02; 4-year OS 92% vs 73%,
P=0.033). However, when calculated from diagnosis, EFS and OS of the up-fr
ont and salvage groups were virtually identical, implying that the longer s
urvival post SCT in the up-front group was completely compensated by the lo
nger interval between diagnosis and transplant in the salvage group. Median
OS from diagnosis was 13.5 years. Except for one case of anaplastic large
cell lymphoma, secondary neoplasms have not occurred to date. In conclusion
, our data indicate that SCT might improve the prognosis of patients with d
isseminated FL, although it is probably not curative even if applied early
during the course of the disease. The optimum timing of SCT remains to be d
etermined by the ongoing randomized multicenter trial of the German Low-gra
de Lymphoma Study Group. The impact of radiotherapy on the success of SCT d
oes not seem to be as essential as originally believed.