Autologous Stem Cell Transplantation for Follicular Lymphoma

High-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) has contributed to modify the natural history of follicular lymphoma (FL); however, an overall survival (OS) benefit has been demonstrated at relapse only after a rituximab-free chemotherapy regimen. A total of 655 p...

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Detalles Bibliográficos
Autores: Jimenez-Ubieto, Ana|||0000-0003-0892-8682, Grande, Carlos, Caballero, Dolores|||0000-0002-9544-9614, Yáñez, Lucrecia|||0000-0001-9925-3048, Novelli, Silvana|||0000-0001-8750-0195, Hernández-Garcia, Miguel Teodoro, Manzanares, María, Arranz, Reyes, Ferreiro, José Javier, Bobillo, Sabela|||0000-0001-7381-680X, Mercadal, Santiago|||0000-0003-4741-7885, Galeo, Andrea, López Jiménez, Javier, Moraleda, José María|||0000-0001-9080-1466, Vallejo, Carlos, Albo, Carmen, Pérez, Elena, Marrero, Carmen, Magnano, Laura|||0000-0002-6928-8386, Palomera, Luis|||0000-0003-0359-7191, Jarque, Isidro|||0000-0001-5673-4490, Martínez Sánchez, Pilar|||0000-0002-7334-140X, Martín, Alejandro, Coria, Erika, López Guillermo, Armando|||0000-0002-8588-8381, Salar Silvestre, Antonio|||0000-0002-4652-4825, Lahuerta, J. J.|||0000-0002-3393-9570
Tipo de recurso: artículo
Fecha de publicación:2017
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:289125
Acceso en línea:https://ddd.uab.cat/record/289125
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2017.05.021
Access Level:acceso abierto
Palabra clave:Autologous stem cell
Follicular lymphoma
Long-term follow-up
Rituximab
Trasplantation
Descripción
Sumario:High-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) has contributed to modify the natural history of follicular lymphoma (FL); however, an overall survival (OS) benefit has been demonstrated at relapse only after a rituximab-free chemotherapy regimen. A total of 655 patients with FL were reported to the Spanish GELTAMO (Grupo Español de Linfomas y Trasplantes de Médula Ósea) registry and underwent first ASCT between 1989 and 2007. A total of 203 patients underwent ASCT in first complete response (CR1), 174 in second complete response (CR2), 28 in third complete response (CR3), 140 in first partial response (PR1), 81 in subsequent PR, and 29 with resistant/refractory disease; 184 patients received rituximab before ASCT. With a median follow-up of 12 years from ASCT, median progression-free survival (PFS) and overall survival (OS) were 9.7 and 21.3 years, respectively. Actuarial 12-year PFS and OS were 63% (95% confidence interval [CI], 58%-68%) and 73% (95% CI, 68%-78%), respectively, for patients in CR (with a plateau in the curve beyond 15.9 years), 25% (95% CI, 19%-28%) and 49% (95% CI 42%-56%), respectively, for patients in PR, and 23% (95% CI, 8%-48%) and 28% (95% CI, 9%-45%), respectively, for patients with resistant/refractory disease (P <.001). In patients who received rituximab before ASCT, the estimated 9-year PFS and OS from ASCT were 59.5% (95% CI, 51%-67%) and 75% (95% CI, 68%-83%), respectively. Interestingly, for patients who underwent transplantation in CR ≥2 or PR ≥2 who had received rituximab before ASCT (n = 90), 9-year PFS and OS were 61% (95% CI, 51%-73%) and 75% (95% CI, 65%-80%), respectively, with no relapses occurring beyond 5.1 years after ASCT. The cumulative incidence of second malignancies in the global series was 6.7% at 5 years and 12.8% at 10 years. This analysis strongly suggests that ASCT is a potentially curative option for eligible patients with FL. In the setting of relapse, it is of especial interest in pretransplantation rituximab-sensitive patients with FL.

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