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 non-Hodgkin's lymphoma 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 Medical Oncology 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 lymphoma patients. 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 chemotherapy combined with ASCT did not improve overall survival in previously untreated adult patients 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significant treatment effect or those that stopped early because of toxic effects in the ASCT arm are more likely not to be published." They add that data from the unpublished trials should be made available to better assess treatment effects and to develop future clinical trials. "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 follicular lymphoma, 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."
-end-
Contact Info:

Article: Michael Crump, MD, FRCPC Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Avenue, 5-110, Toronto, ON M5G 2M9, Canada
Email: Michael.Crump@uhn.on.ca

Editorial: Caron Jacobson MD Dana-Farber Cancer Institute 450 Brookline Avenue Boston, MA 02215
Email: cajacobson@partners.org

Journal of the National Cancer Institute

Related Chemotherapy Articles from Brightsurf:

Chemotherapy is used to treat less than 25% of people with localized sarcoma
UCLA researchers have found that chemotherapy is not commonly used when treating adults with localized sarcoma, a rare type of cancer of the soft tissues or bone.

Starved cancer cells became more sensitive to chemotherapy
By preventing sugar uptake, researchers succeeded in increasing the cancer cells' sensitivity to chemotherapeutic treatment.

Vitamin D could help mitigate chemotherapy side effects
New findings by University of South Australia researchers reveal that Vitamin D could potentially mitigate chemotherapy-induced gastrointestinal mucositis and provide relief to cancer patients.

Less chemotherapy may have more benefit in rectal cancer
GI Cancers Symposium: Colorado study of 48 patients with locally advanced rectal cancer receiving neoadjuvant chemotherapy, found that patients receiving lower-than-recommended doses in fact saw their tumors shrink more than patients receiving the full dose.

Male fertility after chemotherapy: New questions raised
Professor Delb├Ęs, who specializes in reproductive toxicology, conducted a pilot study in collaboration with oncologists and fertility specialists from the McGill University Health Centre (MUHC) on a cohort of 13 patients, all survivors of pediatric leukemia and lymphoma.

'Combo' nanoplatforms for chemotherapy
In a paper to be published in the forthcoming issue in NANO, researchers from Harbin Institute of Technology, China have systematically discussed the recent progresses, current challenges and future perspectives of smart graphene-based nanoplatforms for synergistic tumor therapy and bio-imaging.

Nanotechnology improves chemotherapy delivery
Michigan State University scientists have invented a new way to monitor chemotherapy concentrations, which is more effective in keeping patients' treatments within the crucial therapeutic window.

Novel anti-cancer nanomedicine for efficient chemotherapy
Researchers have developed a new anti-cancer nanomedicine for targeted cancer chemotherapy.

Ending needless chemotherapy for breast cancer
A diagnostic test developed at The University of Queensland might soon determine if a breast cancer patient requires chemotherapy or would receive no benefit from this gruelling treatment.

A homing beacon for chemotherapy drugs
Killing tumor cells while sparing their normal counterparts is a central challenge of cancer chemotherapy.

Read More: Chemotherapy News and Chemotherapy Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.