Durable event-free survival following autologous stem cell transplant for relapsed or refractory follicular lymphoma: positive impact of recent rituximab exposure and low-risk Follicular Lymphoma International Prognostic Index score

Abstract

Published studies have provided conflicting results regarding the curative potential of high dose chemotherapy and autologous stem cell transplant (HDT/ASCT) for follicular lymphoma (FL). Our objectives were to evaluate the long-term event-free (EFS) and overall (OS) survival rates following ASCT for FL, and to identify predictors of improved outcome. We conducted a retrospective analysis of the first 100 consecutive patients with relapsed or refractory FL treated with HDT/ASCT in Calgary from 1993 to 2008. With a median follow-up of 65 months (range 16–178) post-ASCT, 5-year EFS and OS rates were 56% (95% confidence interval [CI] 46–66%) and 70% (95% CI 61–79%), respectively. A plateau on the EFS curve is evident starting 6 years post-ASCT. Also, the EFS post-ASCT was markedly longer than the 12-month median EFS from last therapy prior to ASCT (p < 0.0001). Failure of rituximab pre-ASCT was not associated with EFS or OS. Severe toxicities included two early treatment-related deaths, and four late deaths from secondary leukemia. Independent predictors of EFS and OS in multivariate analysis were rituximab therapy within 6 months of ASCT, chemosensitivity and FLIPI (FL International Prognostic Index) score 0–1. In conclusion, our data suggest that over 50% of patients with relapsed/refractory FL who have failed 1–2 prior chemotherapy regimens achieve long-term EFS following HDT/ASCT.

Keywords::

• Clinical results
• lymphoma and Hodgkin disease
• prognostication
• immunotherapy

Acknowledgements

We would like to acknowledge Jan McLaughlin for maintaining the transplant database, and physicians and nurses on the BMT team for excellent clinical care of patients.

D. Stewart has received research funding and honoraria from Hoffmann La Roche, Canada.

Potential conflict of interest:

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