A long term follow up study of autologous transplantation for follicular lymphoma: a single center experience

Abstract

Appropriate timing of transplant in the management of follicular lymphoma (FL) is not clear. We retrospectively evaluated our experience of autologous transplantation in patients with FL from 1991 to 2003. Seventeen males and 7 females (n = 24) of median age 47.5 years (range, 28–64 years) were treated. Three patients were in first remission. Twenty one patients were salvaged after relapse with second line chemotherapy. Of these, 14 were in CR or very good PR at the time of transplantation, and 7 patients were transplanted with active disease. Bone marrow was used in 6 patients as the source of stem cells prior to 1995 and peripheral blood stem cells were used in 18 patients. The median CD34+ cell dose was 2.97 × 106/kg (range, 2.22–7.49 × 106/kg). Twenty-three of 24 patients engrafted (96%). Median time for neutrophil recovery was 11.5 days (range, 9–35 days) and 15 days (range, 10–40 days) for platelets. Median duration of follow up was 6 years (range, 7 month–8 years). Of the 24 patients, 6 had died. One patient died from transplant related pulmonary complication. Overall survival (OS) and disease free survival (DFS) of all evaluable patients were 71.6% and 40%. Median duration of response was 4.3 years. OS and DFS in patients transplanted in CR were 80% and 57%. For those transplanted with disease, a complete response was achieved in 43% of patients, with the OS and DFS of 57% and 19 % respectively. Status at transplantation was not a significant variable for survival (p > 0.3). Three patients developed moderate to severe treatment related toxicity; 2 with Grade III mucositis and 1 with life threatening infection. In our experience, high dose therapy with autologous stem cell transplantation in patients with high risk or relapsed/refractory FL has little toxicity and appears to be effective. Those with more advanced disease may require additional approaches to achieve and maintain remission.