High-dose therapy and autologous stem cell transplant for transformed non-Hodgkin lymphoma in the rituximab era

James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY , USA.
Leukemia & lymphoma (Impact Factor: 2.89). 12/2011; 53(5):830-5. DOI: 10.3109/10428194.2011.631637
Source: PubMed


The impact of rituximab on the outcome of high-dose therapy and autologous stem cell transplant (HD-ASCT) for transformed non-Hodgkin lymphoma (NHL) has not been previously described. We analyzed 18 consecutive patients with indolent NHL who transformed to diffuse large B-cell lymphoma (DLBCL), received rituximab-containing therapy either before or after transformation and underwent subsequent HD-ASCT. With a median follow-up of 40 months, the 2-year progression-free survival (PFS) was 59% and the 2-year overall survival (OS) was 82%. Six patients did not receive rituximab pre-transformation. This group had a significantly better PFS at 2 years post-HD-ASCT compared to 12 patients who were exposed to rituximab pre-transformation (p = 0.03). HD-ASCT remains an effective therapeutic option for transformed NHL in the rituximab era. However, patients exposed to rituximab pre-transformation appear to have inferior HD-ASCT outcomes, and thus may benefit from novel conditioning and maintenance regimens in the setting of HD-ASCT.

Download full-text


Available from: Laurie A Milner, Apr 10, 2015
41 Reads
  • Source
    • "The impact of rituximab has not been established yet, but ASCT seems to remain an effective option for transformed FL.26 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Follicular lymphoma (FL) remains incurable despite advances in new strategies of treatment, including monoclonal antibodies (MoAb). Except for early stages, FL is characterized by responses to treatments and systematic relapses. The main objective in this disease is to achieve a better progression free survival (PFS) and to increase overall survival (OS), mainly in young patients. In order to improve the results of conventional chemotherapy, autologous stem cell transplant (ASCT) is a feasible treatment in these patients. In this moment, ASCT is not recommended as first line treatment, except for transformed FL, but is a good strategy as salvage therapy with an improved PFS and OS. New drugs have been introduced to enhance responses of ASCT, but nowadays they are not part of conventional conditioning regimen.
    Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012074. DOI:10.4084/MJHID.2012.074
  • Source
    Leukemia & lymphoma 02/2012; 53(5):754-5. DOI:10.3109/10428194.2012.656637 · 2.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The transformation of follicular lymphoma to an aggressive lymphoma is a well-recognised complication that occurs at a rate of approximately 3 % a year for the first 10 years of observation. Transformation is accompanied by increased risk of refractoriness and a poor expectation of survival. Genetic and epigenetic triggers for transformation have been described. Prior to routine use of rituximab, transformed lymphoma was managed in a fashion similar to that for de novo diffuse large B-cell lymphoma, with generally poor results. Rituximab appears to have improved outcomes. Some centres, including our own, use high-dose chemotherapy with stem cell transplantation as consolidation for those with responsive disease. Here, we focus on transformed follicular lymphoma, and provide an overview of the current literature and our approach to management.
    Current Oncology Reports 08/2012; 14(5):424-32. DOI:10.1007/s11912-012-0258-4 · 2.89 Impact Factor
Show more