Transformed Follicular Lymphoma: Is Early Autologous Stem Cell Transplantation Indicated in the Modern Era?

Transformation of follicular lymphoma (FL) is associated with an aggressive course and rapid decline in survival. Inclusion of auto logous stem cell transplant (auto-SCT) in the initial treatment of transformed FL (tFL) has been investigated; but most studies pre-date the widespread use of rituximab. The role of early auto- SCT in the current immunotherapy era is not established. This study reports the outcomes of 105 patients with tFL treated at a single institution between 1994 and 2009. 24 patients underwent auto-SCT in first remission. Rituximab was part of the initial therapy for tFL in 86%, and 56% were chemotherapy naïve at transformation. Median follow-up was 44 months. The 2-year and 5-year overall survival (OS) rates for all patients were 78% and 65%, respectively. Survival did not differ among those patients who underwent auto-SCT (PFS 42% and OS 74% at 5 years) compared to those who did not (PFS 30% and OS 63% at 5 years). Age over 60 was associated with worse OS. In conclusion, we did not observe a benefit in PFS or OS when auto-SCT was included in the initial therapy of tFL.