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High-dose therapy followed by autologous purged stem cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by the GOELAMS with final results after a median follow-up of 9 years.
- Source :
-
Blood [Blood] 2009 Jan 29; Vol. 113 (5), pp. 995-1001. Date of Electronic Publication: 2008 Oct 27. - Publication Year :
- 2009
-
Abstract
- Autologous stem cell transplantation (ASCT) as first-line therapy for follicular lymphoma (FL) remains controversial. The multicenter study randomized 172 patients with untreated FL for either immunochemotherapy or high-dose therapy (HDT) followed by purged ASCT. Conditioning was performed with total body irradiation (TBI) and cyclophosphamide. The 9-year overall survival (OS) was similar in the HDT and conventional chemotherapy groups (76% and 80%, respectively). The 9-year progression-free survival (PFS) was higher in the ASCT than the chemotherapy group (64% vs 39%; P = .004). A PFS plateau was observed in the HDT group after 7 years. On multivariate analysis, OS and PFS were independently affected by the per-formance status score, the number of nodal areas involved, and the treatment group. Secondary malignancies were more frequent in the HDT than in the chemotherapy group (6 secondary myelodysplastic syndrome/acute myeloid leukemia and 6 second solid tumor cancers vs 1 acute myeloid leukemia, P = .01). The occurrence of a PFS plateau suggests that a subgroup of patients might have their FL cured by ASCT. However, the increased rate of secondary malignancies may discourage the use of purged ASCT in combination with TBI as first-line treatment for FL. This trial has been registered with ClinicalTrials.gov under identifier NCT00696735.
- Subjects :
- Adolescent
Adult
Cyclophosphamide administration & dosage
Disease-Free Survival
Female
Follow-Up Studies
Humans
Immunotherapy methods
Male
Middle Aged
Myeloablative Agonists administration & dosage
Survival Rate
Transplantation, Autologous
Whole-Body Irradiation
Bone Marrow Purging
Lymphoma, Follicular mortality
Lymphoma, Follicular therapy
Neoplasms, Second Primary mortality
Stem Cell Transplantation
Transplantation Conditioning
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 113
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 18955565
- Full Text :
- https://doi.org/10.1182/blood-2008-05-160200