Originally published as JCO Early Release 10.1200/JCO.2007.15.5358 on June 16 2008

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Impact of Rituximab and/or High-Dose Therapy With Autotransplant at Time of Relapse in Patients With Follicular Lymphoma: A GELA Study

Catherine Sebban, Pauline Brice, Richard Delarue, Corinne Haioun, Bertrand Souleau, Nicolas Mounier, Nicole Brousse, Pierre Feugier, Hervé Tilly, Philippe Solal-Céligny, Bertrand Coiffier

From the Centre Léon Bérard, Lyon; Hôpital Saint-Louis, Assistance Publique, Paris; Hôpital Necker, Assistance Publique, Paris; Hôpital Henri Mondor, Assistance Publique, Créteil; HIA Percy, Clamart; l'Archet, Centre Hospitalier Universitaire, Nice; Hôpital Necker, Paris; Hôpital de Brabois, Vandoeuvre les Nancy; Centre Henri Becquerel, Rouen; Clinique Jean Bernard Le Mans; and the Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France

Corresponding author: Bertrand Coiffier, MD, Centre Hospitalier Lyon-Sud, Service d'Hématologie, Pierre Benite, Ce, France 69495; e-mail: bertrand.coiffier{at}chu-lyon.fr

Purpose: The treatment of patients with follicular lymphoma has changed with the introduction of high-dose therapy (HDT) with autologous stem-cell transplant then with rituximab. The effect of these two strategies on the outcome of relapsing patients with follicular lymphoma has never been compared.

Patients and Methods: We analyzed two cohorts of patients treated in two successive randomized studies with the same treatment, cyclophosphamide, doxorubicin, teniposide, and prednisolone plus interferon, to evaluate the role of rituximab and HDT in salvage therapy after first disease progression or relapse.

Results: Of the 364 patients included in these two studies, 254 progressed or relapsed and constitute the population of this analysis. Among them, 98 had been treated with HDT, including 33 of them after rituximab-containing salvage regimen, and 69 with rituximab alone or combined with chemotherapy but without HDT. Patients’ characteristics at diagnosis were similar in all subgroups. If event-free survival was identical for patients treated within Groupe d'Etude des Lymphomes Folliculaires (GELF) -86 or GELF-94 studies, overall survival was longer in GELF-94 study. HDT was associated with a statistically significant benefit in terms of event-free survival from relapse and survival after relapse (SAR). Rituximab was associated with a greater benefit than HDT for these two end points. When both treatments were combined, patients treated with rituximab-containing salvage regimen followed by HDT had 5-year SAR more than 90%.

Conclusion: In follicular lymphoma, for patients treated with first-line chemotherapy the combination of a salvage regimen containing rituximab with or without HDT leads to a dramatic improvement of long-term outcome.

published online ahead of print at www.jco.org on June 16, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.