Results of Autotransplantation in Follicular Large-Cell Lymphoma.

The role of autotransplantation in the treatment of large-cell follicular lymphoma is uncertain. We analyzed results of autotransplantation performed from 1/91 through 7/06 in follicular large-cell non-Hodgkin’s lymphoma (NHL) at 3 institutions using preparation with busulfan, cyclophosphamide and VP-16 and compared results to those of patients with diffuse large-cell NHL (DLCL) receiving identical preparation over the same period. Fifty-nine patients with follicular large-cell NHL (FLCL) were compared to 430 patients with DLCL. There were no significant differences between the 2 groups in regards to age (DLCL: median 51 years; range 18–74 years; follicular: median 55 years; range 33–77years), sex, remission status at transplantation, bulky disease at diagnosis, or follow-up(median 4 years). Bone marrow involvement at diagnosis occurred more frequently in FLCL patients (P=0.03). Regimen-related mortality at 100 days for patients with FLCL is 4% (95% CI: 0-14%); estimated relapse-free survival at 4 years is 53% (95% CI: 20-83%) and relapse rate at 4 years is 43% (95% CI: 13%-73%). Relapses beyond 4 years occurred in 2 patients with FLCL and 4 with DLCL. Relapse-free survival was adversely affected in both groups by chemotherapy resistant disease or transplantation beyond second remission (P=0.02). There were no significant differences between the two groups in the incidence of early mortality, 4 year lymphoma-free survival, relapse rate at 4 years, or relapse beyond 4 years. In conclusion, the results of autotransplantation in FLCL are similar to those in DLCL. Patients who undergo transplantation in chemosensitive first relapse or earlier have favorable outcomes. Late relapse occurs infrequently.