Published in:
01-05-2015 | Original Article
Prolonged clinical remissions in patients with relapsed or refractory follicular lymphoma treated with autologous stem cell transplantation incorporating rituximab
Authors:
N. L. Berinstein, S. Bhella, N. M. Pennell, M. C. Cheung, K. R. Imrie, D. E. Spaner, V. Milliken, L. Zhang, K. Hewitt, A. Boudreau, M. D. Reis, A. Chesney, D. Good, Z. Ghorab, L. K. Hicks, E. Piliotis, R. Buckstein
Published in:
Annals of Hematology
|
Issue 5/2015
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Abstract
Three sequential phase II trials were conducted with different immunotherapy approaches to enhance the outcome of autologous transplant (high-dose therapy and autologous stem cell transplantation (HDT/ASCT)) for recurrent follicular lymphoma. Seventy-three patients were enrolled from 1996 to 2009. Patients received HDT/ASCT combined with (1) interferon-α 3 MU/m2 subcutaneously (SC) three times per week (TIW) for 2 years post-ASCT, (2) rituximab (R) 375 mg/m2 for in vivo purging 3–5 days pre-stem cell collection and 2 × 4 weekly R at 2 and 6 months post-ASCT, respectively, or (3) three infusions of R pre-stem cell collection followed by 6× R weekly and interferon-α 3 MU/m2 SC TIW. Although not statistically significant, progression-free survival (PFS) for patients who received rituximab was 56.4 and 49.1 % at 5 and 10 years compared to 36 and 21 % in those who did not receive rituximab. Molecular relapse post-HDT/ASCT was the strongest predictor of PFS in a multivariate analysis. Molecular relapse was coincident with or preceded clinical relapses in 84 % of patients who relapsed—median of 12 months (range 0–129 months). Adverse events included secondary malignancy, transformation to diffuse large B cell lymphoma, prolonged mostly asymptomatic hypogammaglobulinemia, and pulmonary fibrosis. The long-term toxicity profile must be considered when selecting patients for this treatment.