2003: Long Term Relapse Free Survival Is Possible after Auto SCT for
Martin Kornacker, Yasemin Ipek, Stephan Probst, Fatime Krasniqi, Matthias Villalobos, Rainer Haas, Manfred Hensel, Anthony D. Ho Department of Internal Medicine V, University of Heidelberg, Germany; Department of Hematology, Oncology and Immunology, University Duesseldorf, Germany
SAMPLE: Between 1990 and 2002, 156 patients (pts) with follicular lymphoma received high-dose chemotherapy and autologous stem cell transplantation. Pts received high-dose therapy if they have relapsed after conventional therapy or if they had high-risk factors. In the latter case they were transplanted as part of the primary treatment strategy.
A PCR result for t(14;18) in bone marrow and peripheral blood at the time of transplantation and in the leukapheresis product was available in 96 pts.
Median age of the patient population was 46 years (range 22-65). 53% of pts. were male, 47% female. 9 pts. had stage I/II, 30 stage III and 117 stage IV disease.
The conditioning regimen consisted either of high dose
cyclophosphamide (200 mg/kg) and 14.4 Gy TBI (74% of pts) or BEAM (26%).
After a median follow up time of 62 months (1-149 months), 123 pts. were alive (78,8%).
11 pts. died from infection (7.1%), 17 (10.9%) from relapse and 5 pts. (3.1%) from other causes.
Secondary malignancies occured in 6 cases (3,8%; 1 lung cancer, 1 breast cancer, 1 gastric cancer, 1 malignant melanoma, 1 Hodgkins disease, 1 MDS/AML).
Relapse rate was 26.9%. Kaplan-Meier analysis showed a stable plateau after 70 months at 65% relapse free survival.
Age at time of transplantation of 50 years or older was associated with a reduced OS (p=0,02).
No correlation could be detected between OS/RFS (Overall survival/Relapse Free Survival) and
* stage at diagnosis,
* bulky disease,
* extranodal disease and
* detection of circulating tumor cells (t(14;18)) at the day of transplantation in peripheral blood or bone marrow.
There was a trend for longer RFS when the leukapheresis product was tumor cell free (p=0,07).
OS and RFS was not influenced by:
*response to previous therapies (CR vs PR),
* rituximab in previous therapies,
* CD34 selection of the graft or the type of conditioning regimen, albeit pts conditioned with TBI/Cy needed more time before reaching platelet counts above 20/nl (TBI/Cy 18,2 days, BEAM 11,2 days, p=0,03).
Interestingly, RFS was significantly increased when more than one therapy regimen (radiation or chemotherapy) was given before transplantation (p=0,02).
OS was increased when pts were transplanted in CR vs. PR (p=0,03). Compared to transplantation in 2nd remission, transplantation in 1st remission led to increased PFS (p=0,02), without influence on OS.
Taken together, only age and remission status at time of transplantation proved to be of relevance for OS in our patient population. CD34 selection, MRD negativity and conditioning regimen had no impact on post-transplant survival.
** Autologous transplantation up-front did not increase survival as compared to relapse transplantation. **