Sequential therapy with alternating short courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-FM (rituximab, fludarabine, mitoxantrone) followed by autologous stem cell transplantation results in long term remission in advanced follicular lymphoma

摘要

Follicular lymphoma (FL) remains incurable with standard therapeutic approaches (Laport, 2012), and the majority of patients experience multiple relapses, with consequent sequential exposure to many different chemotherapy regimens during the disease course. As the natural history of the disease progresses the quality and duration of remissions decreases and, particularly at later disease stages, the therapeutic window for regimens might be reduced because of persistent myelosuppression. Autologous bone marrow transplantation (ASCT) is routinely performed at disease relapse in high risk patients but the available data do not support its use as first line consolidation, given the lack of overall survival (OS) advantage compared to standard therapy (Ladetto et al, 2008). Given that the most important factor influencing ASCT outcome is disease burden at the time of ASCT, the quality of response to pretransplant therapy is crucial in determining the final outcome (Derenzini et al, 2008).