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 GOELAMS.

Abstract

Doxorubicin-based immunochemotherapy, with interferon, has been shown to improve survival in patients with advanced follicular lymphoma. High-dose chemotherapy with stem-cell support is effective in follicular lymphoma in relapse but remains controversial as a first-line therapy. In a randomized study using a purged autologous stem-cell support, we compared these 2 approaches in patients with advanced follicular lymphoma. Newly diagnosed advanced follicular lymphoma patients (172 patients) were randomly assigned either to an immunochemotherapy regimen (cyclophosphamide, doxorubicin, teniposide, prednisone, and interferon) or to a high-dose therapy followed by purged autologous stem-cell transplantation. Compared with the patients who received chemotherapy and interferon, patients treated with high-dose therapy had a higher response rate (69% vs 81%, P = .045) and a longer median event-free survival (not reached vs 45 months). This did not translate into a better survival rate due to an excess of secondary malignancies after transplantation. The Follicular Lymphoma Prognostic Index identified a subgroup of patients with a significantly higher event-free survival rate after high-dose therapy. Autologous stem-cell transplantation cannot be considered as the standard first-line treatment of follicular lymphoma for patients younger than 60 years old with a high tumor burden.

• Authors: Eric Deconinck, Charles Foussard, Noel Milpied, Philippe Bertrand, Patrick Michenet, Pascale Cornillet-LeFebvre, Martine Escoffre-Barbe, Herve Maisonneuve, Vincent Delwail, Remy Gressin, Eric Legouffe, Jean-Pierre Vilque, Bernard Desablens, Jerome Jaubert, Jean-François Ramee, Arash Jenabian, Antoine Thyss, Annick Le Pourhiet-Le Mevel, Philippe Travade, Roselyne Delepine, Philippe Colombat, GOELAMS
• Journal: Blood (Blood) Vol. 105 Issue 10 Pg. 3817-23 (May 15 2005) ISSN: 0006-4971 [Print] United States
• PMID: 15687232 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Doxorubicin

Topics

• Adult
• Disease Progression
• Doxorubicin (adverse effects, therapeutic use)
• Feasibility Studies
• Female
• Follow-Up Studies
• France
• Humans
• Lymphoma, Follicular (drug therapy, pathology, surgery, therapy)
• Male
• Middle Aged
• Neoplasm Staging
• Recurrence
• Stem Cell Transplantation
• Survival Rate
• Transplantation, Autologous