Efficacy and safety of high-dose chemotherapy with in vivo purged auto-SCT in relapsed follicular lymphoma: long-term follow-up.

摘要

Follicular lymphoma (FL) represents 20-25% of all non-Hodgkin's lymphomas. Although response rate to first-line chemotherapy is high, most patients ultimately relapse. After the first relapse, each subsequent therapy can only obtain a remission shorter than the previous. The use of high-dose therapy (HDT), hematopoietic progenitor cells (HPCs) transplantation and rituximab at relapse has been shown to improve outcome, with longer OS than with conventional chemotherapy. Positive results have been reported recently from prospective trials and registry studies, but follow-up is short or details of therapy are missing. Only one group has published data from a randomized study. However, this trial was performed in the 'pre-rituximab' era, HPCs were ex vivo purged and were not subjected to molecular analysis. In addition, there has been concern about toxicity of the conditioning regimen with a significant increase of secondary tumors and myelodysplastic syndromes after TBI, despite a plateau in remission duration curve. Therefore, additional survival data and longer follow-up are needed to assess the role of HDT, HPC transplantation and rituximab for in vivo purging and therapy in relapsed FL (rFL). In addition, clinical and molecular data have to be used to tailor a response-adapted therapy to lessen toxicity.