Autologous stem cell transplantation for advanced follicular lymphoma – One centre experience

Introduction: Follicular lymphoma (FL) is a malignant disorder characterized by clonal proliferation of normal germinal centre B cells. Standard induction treatment includes anti-CD20 monoclonal antibody combined with chemotherapy. However highdose therapy followed by autologous stem cell transplantation (ASCT) is becoming more widely used, especially as a remission consolidation in patients with advanced disease or as a second-line therapy, leading to improved progressionfree survival (PFS) rates. Patients and Methods: We retrospectively evaluated the results of ASCT for 49 FL patients (25 male and 24 female) at median age of 50 years (range 20–71 years) transplanted in our centre between 1993 and 2012. 92% of transplanted patients had III/IV disease stage at diagnosis. Patients achieving first or subsequent complete (CR) or partial response (PR) after conventional chemotherapy were proceeded to ASCT. Results: The induction treatment consisted of R-CHOP (rituximab, cyclophosphamide, vincristine, adriamycin, prednisone) in 28 patients, CHOP in 8 patients, R-CVP (rituximab, cyclophosphamide, vincristine, prednisone) in 9 patients and other schema in 4 cases. The complete response was achieved in 26 patients (53%), and the partial response in 23 patients (47%). Conditioning regimen before ASCT consisted of CBV (cyclophosphamide, BCNU, etoposide) and BEAM (BCNU, cytarabine, etoposide, melphalan) for 43 and 3 patients, respectively. Six patients died 100 days after ASCT giving the transplant-related mortality (TRM) of 12%. The causes of death were infections and disease relapse. The median follow-up from ASCT is 2.5 years (range 0.03–19.06). The 3-year probability of overall survival (OS) for patients transplanted in CR was 59% and in PR was 49%, respectively. Twenty patients (41%) died due to disease progression and the remaining 29 were in CR. Conclusion: ASCT as a consolidation of remission for patients with FL after achieving first complete or partial response were found to be effective and relatively safe procedure.