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 the GOELAMS with final results after a median follow-up of 9 years.
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| Abstract |
Autologous stem cell transplantation (ASCT) as first-line therapy for follicular lymphoma (FL) remains controversial. The multicenter study randomized 172 patients with untreated FL for either immunochemotherapy or high-dose therapy (HDT) followed by purged ASCT. Conditioning was performed with total body irradiation (TBI) and cyclophosphamide. The 9-year overall survival (OS) was similar in the HDT and conventional chemotherapy groups (76% and 80%, respectively). The 9-year progression-free survival (PFS) was higher in the ASCT than the chemotherapy group (64% vs 39%; P = .004). A PFS plateau was observed in the HDT group after 7 years. On multivariate analysis, OS and PFS were independently affected by the per-formance status score, the number of nodal areas involved, and the treatment group. Secondary malignancies were more frequent in the HDT than in the chemotherapy group (6 secondary myelodysplastic syndrome/acute myeloid leukemia and 6 second solid tumor cancers vs 1 acute myeloid leukemia, P = .01). The occurrence of a PFS plateau suggests that a subgroup of patients might have their FL cured by ASCT. However, the increased rate of secondary malignancies may discourage the use of purged ASCT in combination with TBI as first-line treatment for FL. This trial has been registered with ClinicalTrials.gov under identifier NCT00696735.
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| Authors | Emmanuel Gyan, Charles Foussard, Philippe Bertrand, Patrick Michenet, Steven Le Gouill, Christian Berthou, Hervé Maisonneuve, Vincent Delwail, Rémi Gressin, Philippe Quittet, Jean-Pierre Vilque, Bernard Desablens, Jérôme Jaubert, Jean-François Ramée, Nina Arakelyan, Antoine Thyss, Cécile Moluçon-Chabrot, Roselyne Delépine, Noël Milpied, Philippe Colombat, Eric Deconinck, Groupe Ouest-Est des Leucémies et des Autres Maladies du Sang (GOELAMS) |
| Journal | Blood (Blood) Vol. 113 Issue 5 Pg. 995-1001 (Jan 29 2009) ISSN: 1528-0020 [Electronic] United States |
| PMID | 18955565 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't) |
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