The impact of total body irradiation on the outcome of patients with follicular lymphoma treated with autologous stem cell transplantation in the modern era. A retrospective study of the EMBT lymphoma working party
Menée sur 2 233 patients atteints d'un lymphome folliculaire et ayant reçu une greffe autologue de cellules souches hématopoïétiques entre 1995 et 2007 (durée médiane de suivi : 73 mois), cette étude évalue, par rapport à une chimiothérapie de conditionnement de type BEAM, l'effet d'une irradiation corporelle totale sur la mortalité sans récidive à 5 et 10 ans et sur le risque de syndrome myelodysplasique ou de leucémie myéloblastique aiguë liés au traitement
Background : The aim of this study was to investigate the impact of the high-dose regimen on the outcome of patients with follicular lymphoma (FL) having had autologous stem cell transplantation (ASCT) in a recent time period. Patients : Between 1995 and 2007, 2233 patients with FL had their first ASCT with either a total body irradiation-containing regimen (TBI) or BEAM, of which 47% were autografted in first remission. Results : After a median observation time of 73 months (interquartile range 30-107), 5- and 10-year non-relapse mortality (NRM) was similar (6% and 10% in both groups). No significant NRM differences became evident after multivariate adjustment for confounders. Secondary malignancies were observed in 9.7% and 7.9% of the patients after TBI and BEAM (p=0.19), which were t-MDS/AML in 3.4% and 2.8% (p=0.57). The median time to t-MDS/AML was around 50 months in both groups. Because of a lower relapse incidence, TBI was associated with better event-free survival reaching statistical significance in the patients transplanted in first remission but not in those transplanted beyond first remission. Conclusions : In patients with FL who received TBI-based ASCT after 1995 increased NRM and t-MDS/AML risks did not emerge compared to BEAM whilst disease control was at least equivalent.