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Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: a Follow-Up Study of Two Randomized Trials From the German Low Grade Lymphoma Study Group.

Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: a Follow-Up Study of Two Randomized Trials From the German Low Grade Lymphoma Study Group.
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Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O,


Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O, (click to view)

Jurinovic V, Metzner B, Pfreundschuh M, Schmitz N, Wandt H, Keller U, Dreger P, Dreyling M, Hiddemann W, Unterhalt M, Hoster E, Weigert O,

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Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 2018 03 29() pii S1083-8791(18)30156-3
Abstract

Patients with follicular lymphoma (FL) and progression-of-disease (POD) within 24 months after frontline treatment (POD24) have poor overall survival (OS). The optimal salvage treatment for these patients is unknown. We assessed the role of high-dose therapy and autologous stem cell transplantation (ASCT) in transplant-eligible patients. We analyzed 162 patients with advanced-stage FL who had received frontline treatment within the GLSG1996 or GLSG2000 trials. All patients had POD at age <65 years and had not received a prior transplant. Second-line treatment was not specified by study protocols. Survival was calculated from time of 2-line treatment. Eighteen patients (11%) progressed (n=16) or died (n=2) during cytoreductive 2-line treatment (considered "cytoreduction-failure"); none received ASCT and their median 2-line OS was <1 year. A total of 113 patients had POD24 (70%), 49 had POD after 24 months (POD>24; 30%). Sixty-three patients without cytoreduction-failure received ASCT (39%), 81 received no transplant (50%). In patients with POD24, a significant survival benefit was associated with ASCT with a 5-year 2-line progression free survival for ASCT vs no transplant of 51% vs 19% (HR 0.38, 95%-CI [0.24;0.62], p<0.0001), and a 5-year 2-line OS of 77% vs 59% (HR 0.54, 95%-CI [0.30;0.95], p=0.031). Thus, ASCT is an effective treatment option for transplant-eligible patients with high-risk FL as identified by POD24, and should be evaluated in prospective clinical trials.

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