Autologous Stem Cell Transplantation for Follicular Lymphoma: Favorable Long-Term Survival Irrespective of Pretransplantation Rituximab Exposure
Por:
Jimenez-Ubieto, A, Grande, C, Caballero, D, Yanez, L, Novelli, S, Hernandez-Garcia, MT, Manzanares, M, Arranz, R, Ferreiro, JJ, Bobillo, S, Mercadal, S, Galeo, A, Jimenez, JL, Moraleda, JM, Vallejo, C, Albo, C, Perez, E, Marrero, C, Magnano, L, Palomera, L, Jarque, I, Martinez-Sanchez, P, Martin, A, Coria, E, Lopez-Guillermo, A, Salar, A, Lahuerta, JJ
Publicada:
1 oct 2017
Resumen:
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 Espafiol de Linfomas y Trasplantes de Medula Osea) 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 <.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. (C) 2017 American Society for Blood and Marrow Transplantation.
Filiaciones:
Jimenez-Ubieto, A:
Hosp Univ 12 Octubre, Avda Cordoba S-N, Madrid 28041, Spain
Grande, C:
Hosp Univ 12 Octubre, Avda Cordoba S-N, Madrid 28041, Spain
Caballero, D:
Hosp Univ Salamanca IBSAL, Salamanca, Spain
Yanez, L:
Hosp Univ Marques de Valdecilla, Santander, Spain
Novelli, S:
Hosp Univ Sant Pau, Barcelona, Spain
Hernandez-Garcia, MT:
Hosp Univ Canarias, Tenerife, Spain
Manzanares, M:
Hosp Univ Jerez, Jerez de la Frontera, Spain
Arranz, R:
Hosp Univ La Princesa, Madrid, Spain
Ferreiro, JJ:
Hosp Univ Donostia Aranzazu, San Sebastian, Spain
Bobillo, S:
Hosp Univ Vall de Hebron, Barcelona, Spain
Mercadal, S:
Hosp Univ Bellvitge, Hosp Llobregat, Barcelona, Spain
Galeo, A:
Hosp Univ A Coruna, La Coruna, Spain
Jimenez, JL:
Hosp Univ Ramon & Cajal, Madrid, Spain
Moraleda, JM:
Hosp Univ Virgen Arriaxaca, Murcia, Spain
Vallejo, C:
Hosp Cent Asturias, Asturias, Spain
Albo, C:
Hosp Univ Vigo, Vigo, Spain
Perez, E:
Hosp Univ Morales Messeguer, Murcia, Spain
Marrero, C:
Hosp Univ Nuestra Sellora La Candelaria, Tenerife, Spain
Magnano, L:
Hosp Clin Barcelona, Barcelona, Spain
Palomera, L:
Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Jarque, I:
Hosp Univ La Fe, Valencia, Spain
Martinez-Sanchez, P:
Hosp Univ 12 Octubre, Avda Cordoba S-N, Madrid 28041, Spain
Martin, A:
Hosp Univ Salamanca IBSAL, Salamanca, Spain
Coria, E:
Hosp Clin San Carlos, Madrid, Spain
Lopez-Guillermo, A:
Hosp Clin Barcelona, Barcelona, Spain
Salar, A:
Hosp Mar, Barcelona, Spain
Lahuerta, JJ:
Hosp Univ 12 Octubre, Avda Cordoba S-N, Madrid 28041, Spain
Green Accepted, Hybrid Gold
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