Long-term outcomes of autologous stem cell transplantation for follicular non-Hodgkin’s lymphoma: Effect of histologic grade

Abstract

6567 Background: The potential for long term disease-free survival for patients with recurrent follicular lymphoma receiving high-dose chemotherapy and an autologous hematopoietic stem cell transplant is unknown. Few large studies with extensive follow-up are available for analysis. Methods: Between 7/87 and 6/03, 248 patients (pts) with recurrent follicular non-Hodgkin’s lymphoma (NHL) were treated with high-dose chemotherapy and an autologous stem cell transplant. The median age of the patients was 47 (range 20–67). Sixty-four pts had follicular grade I NHL (FL1), 98 (40%) had follicular grade II (FL2) and 86 (35%) had follicular grade III (FL3). The majority of the patients, 189 (76%) were undergoing transplant > 12 months from the time of their original diagnosis. Pts had received a median of 2 prior chemotherapies and 82% of the patients were chemosensitive to their last chemotherapy regimen. Sixty-seven (27%) of the patients had an elevated lactic dehydrogenase (LDH) at the time of transplant and 81 (35%) of the pts had bone marrow involvement with NHL at the time of transplant. One hundred and ten patients received a chemotherapy only high-dose regimen, 99 received a chemotherapy/total body irradiation regimen, and 39 received a chemotherapy/monoclonal antibody based transplant regimen. Results: The median follow-up of surviving pts is 6.0 years (range 1.0 to 16.0 years). One hundred seventeen patients (47%) have progressed; 80 of whom have subsequently died and 37 remain alive after progression. Thirty-three (13%) have died without NHL progression due to other causes. The overall 5 year event-free survival (EFS) is 44% and the 5 year overall survival (OS) is 63%. The 5 year EFS by histologic grade is FL1 (47%), FL2 (48%), FL3 (36%) (p=0.21). The 5 year OS by histologic type is FL1 (61%), FL2 (70%), FL3 (57%) (p=0.35). Conclusions: Long-term EFS is possible following high-dose chemotherapy and autologous stem cell transplantation for follicular lymphoma. Histologic grade of the follicular lymphoma does not effect the results of the transplant. However, the timing of the transplant does effect outcome with the best results seen in patients in first or second relapse. No significant financial relationships to disclose.