Autologous stem cell transplantation does not improve os in patients with follicular lymphoma

December 21, 2011

High-dose chemotherapy and autologous stem cell transplantation (HDC-ASCT), for previously untreated patients with advanced follicular lymphoma (FL) does not improve overall survival compared with conventional-dose chemotherapy alone, according to an online study published December 21 in the Journal of the National Cancer Institute.

Follicular lymphoma is the most common sub-type of in North America, characterized by a long natural history, with multiple remissions and relapses following treatment. A number of chemotherapy regimens have been combined with ASCT in randomized clinical trials to treat follicular lymphoma, however, the effects of HDC-ASCT on event-free survival have varied.

In order to determine the impact of HDC-ASCT vs conventional-dose chemotherapy in adult patients with advanced follicular lymphoma, Murtadha Al Khabori in the Division of and Hematology at Princess Margaret Hospital in Toronto, Ontario, and colleagues performed a systematic review and meta-analysis of randomized control trials comparing chemotherapy alone to chemotherapy with ASCT.

The researchers identified relevant studies dating from 1947-2009 in the literature and publicly available databases to look at overall survival, event-free survival, and any adverse events associated with treatment from either conventional-dose chemotherapy or high dose-chemotherapy with ASCT.

Seven randomized clinical trials (RCTs) met the eligibility criteria. Of these seven, three showed moderate quality evidence that high-dose chemotherapy with ASCT did not improve the overall survival of adult follicular . The four remaining RTCs highlighted low-quality evidence showing improvement in event-free survival for patients who received chemotherapy with ASCT. The absolute risk of death from treatment and adverse events did not vary between the two treatment groups.

The authors concluded that high-dose combined with ASCT did not improve overall survival in previously untreated with follicular lymphoma. However, the researchers note certain limitations of the study, namely that, "Trials with no statistically significant treatment effect or those that stopped early because of toxic effects in the ASCT arm are more likely not to be published." They add that data from the unpublished trials should be made available to better assess treatment effects and to develop future . "Trials of ASCT in the context of current chemoimmunotherapy approaches in FL are needed to further evaluate the ability of intensification of therapy using ASCT to improve OS," the authors write.

In an accompanying editorial, Caron A. Jacobson and Dan L. Longo, M.D., at the Department of Medicine at Brigham and Women's Hospital in Boston, write that this meta-analysis is timely in light of recent data on the efficacy of maintenance rituximab, which when added to various chemotherapeutic regimens, has improved overall survival. Because of this, along with rituximab's low toxicity profile, Jacobson and Longo conclude, "We recommend rituximab maintenance therapy (in preference to HDC-ASCT) for patients achieving at least a partial response to first-line chemoimmunotherapy in the absence of any randomized controlled trials comparing the two." Furthermore, "HDC-ASCT is a powerful treatment strategy for patients with , but one that does not appear to be less effective in the setting of the first disease relapse than in primary treatment, and thus can be reserved for the salvage setting."

Explore further: More intensive chemotherapy dramatically improves recurrence, survival in younger patients with aggressive lymphoma

Related Stories

More intensive chemotherapy dramatically improves recurrence, survival in younger patients with aggressive lymphoma

November 24, 2011
Younger patients with diffuse large B-cell lymphoma given a more intensive regimen of chemotherapy combined with rituximab survive significantly longer, and are approximately twice as likely to remain in remission 3 years ...

Recommended for you

Study provides insight into link between two rare tumor syndromes

August 22, 2017
UCLA researchers have discovered that timing is everything when it comes to preventing a specific gene mutation in mice from developing rare and fast-growing cancerous tumors, which also affects young children. This mutation ...

Retaining one normal BRCA gene in breast, ovarian cancers influences patient survival

August 22, 2017
Determining which cancer patients are likely to be resistant to initial treatment is a major research effort of oncologists and laboratory scientists. Now, ascertaining who might fall into that category may become a little ...

Study identifies miR122 target sites in liver cancer and links a gene to patient survival

August 22, 2017
A new study of a molecule that regulates liver-cell metabolism and suppresses liver-cancer development shows that the molecule interacts with thousands of genes in liver cells, and that when levels of the molecule go down, ...

Zebrafish larvae could be used as 'avatars' to optimize personalized treatment of cancer

August 21, 2017
Portuguese scientists have for the first time shown that the larvae of a tiny fish could one day become the preferred model for predicting, in advance, the response of human malignant tumors to the various therapeutic drugs ...

Scientists discover vitamin C regulates stem cell function, curbs leukemia development

August 21, 2017
Not much is known about stem cell metabolism, but a new study from the Children's Medical Center Research Institute at UT Southwestern (CRI) has found that stem cells take up unusually high levels of vitamin C, which then ...

Searching for the 'signature' causes of BRCAness in breast cancer

August 21, 2017
Breast cancer cells with defects in the DNA damage repair-genes BRCA1 and BRCA2 have a mutational signature (a pattern of base swaps—e.g., Ts for Gs, Cs for As—throughout a genome) known in cancer genomics as "Signature ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.