Objective To assess the effectiveness and safety of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma.
Method Randomized controlled trials (RCTs) of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma were collected from MEDLINE (1990-2009), EMBASE (1990-2009), OVID (1990-2009), and the Cochrane Library (Issue 2, 2009), and the proceedings of ASH were searched manually. The methodological quality of included studies was evaluated, and data analysis was performed with software STATA 10.0 and RevMan 4.3.
Result A total of 4 RCTs involving 941 patients were included. The results of meta-analysis showed that overall survival rate (HR=0.82, 95%CI 0.49 to 1.15), event-free survival rate (HR=0.35, 95%CI 0.24 to 0.47), total remission rate (RR=0.35, 95%CI 0.96 to 1.30), and secondary malignant tumor incidence rate (RR=1.68, 95%CI 0.47 to 6.07).
Conclusion According to the present evidences, autologous stem cell transplantation after high-dose chemotherapy can not improve overall survival rate and total remission rate, but can improve event-free survival rate, and do not increase secondary malignant tumor incidence rate. However, more high-quality, multiple-center, large-sample randomized controlled trials are required.
Citation：
ZHU Ke,YANG Ying,YANG Wei,ZHANG Rong,HU Rong,JIANG Benchun,LIU Zhuogang. Autologous Stem Cell Transplantation after High-dose Chemotherapy in First-line Treatment of Follicular Lymphoma: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(10): 1169-1173. doi: 10.7507/1672-2531.20100565
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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Colombat P, Donadio D, Fouillard L, et al. Value of autologous bone marrow transplantation in follicular lymphoma: a France autogreffe retrospective study of 42 patients. Bone Marrow Transplant, 1994, 13: 157-162.
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| 2. |
Brice P, Simon D, Bouabdallah R, et al. High-dose therapy with autologous stem-cell transplantation (ASCT) after first progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol. Ann Oncol, 2000, 11: 1585-1590.
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| 3. |
Rohatiner AZ, Johnson PW, Price CG, et al. Myeloablative therapy with autologous bone marrow transplantation as consolidation therapy for recurrent follicular lymphoma. J Clin Oncol, 1994, 12: 1177-1184.
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| 4. |
Rohatiner AZ, Nadler L, Davies AJ, et al. Myeloablative therapy with autologous bone marrow transplantation for follicular lymphoma at the time of second or subsequent remission: long-term follow-up. J Clin Oncol, 2007, 25: 2554-2559.
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| 5. |
Le Gouill, Steven, De Guibert, et al. Autologous stem cell transplantation as the treatment of choice for follicular lymphoma patients in the first replase:final analysis of the outcome of 175 patients treated in the GELA/GOELAMS FL 2000 study. Blood, 2008, 112(11): 287.
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| 6. |
Hiddeman L, Wolfgang MY, Buske AH, et al. Autologous stem cell transplantation after myeloablative therapy in first remission may be beneficial in patients with advanced stage follicular lymphoma after front-line therapy with R-CHOP. An analysis of two consecutive studies of the German low grade lymphoma study group (GLSG). Blood, 2008, 112(11): 286-287.
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| 7. |
Sebban C, Mounier N, Brousse N, et al. Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood, 2006, 108: 2540-2544.
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| 8. |
Deconinck E, Foussard C, Milpied N, et al. High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma:a randomized multicenter study by GOELAMS.Blood, 2005, 105: 3817-3823.
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| 9. |
Lenz G, Dreyling M, Schiegnitz E, et al. Myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission prolongs progression-free survival in follicular lymphoma: results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group. Blood, 2004, 104: 2667-2674.
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| 10. |
Ladetto M, Marco FD, Benedetti F, et al. Prospective, multicenter randomized GITMO/IIL trial comparing intensive (R-HDS) versus conventional (CHOP-R) chemoimmunotherapy in high-risk follicular lymphoma at diagnosis: the superior disease control of R-HDS does not translate into an overall survival advantage. Blood, 2008, 111: 4004-4013.
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- 1. Colombat P, Donadio D, Fouillard L, et al. Value of autologous bone marrow transplantation in follicular lymphoma: a France autogreffe retrospective study of 42 patients. Bone Marrow Transplant, 1994, 13: 157-162.
- 2. Brice P, Simon D, Bouabdallah R, et al. High-dose therapy with autologous stem-cell transplantation (ASCT) after first progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol. Ann Oncol, 2000, 11: 1585-1590.
- 3. Rohatiner AZ, Johnson PW, Price CG, et al. Myeloablative therapy with autologous bone marrow transplantation as consolidation therapy for recurrent follicular lymphoma. J Clin Oncol, 1994, 12: 1177-1184.
- 4. Rohatiner AZ, Nadler L, Davies AJ, et al. Myeloablative therapy with autologous bone marrow transplantation for follicular lymphoma at the time of second or subsequent remission: long-term follow-up. J Clin Oncol, 2007, 25: 2554-2559.
- 5. Le Gouill, Steven, De Guibert, et al. Autologous stem cell transplantation as the treatment of choice for follicular lymphoma patients in the first replase:final analysis of the outcome of 175 patients treated in the GELA/GOELAMS FL 2000 study. Blood, 2008, 112(11): 287.
- 6. Hiddeman L, Wolfgang MY, Buske AH, et al. Autologous stem cell transplantation after myeloablative therapy in first remission may be beneficial in patients with advanced stage follicular lymphoma after front-line therapy with R-CHOP. An analysis of two consecutive studies of the German low grade lymphoma study group (GLSG). Blood, 2008, 112(11): 286-287.
- 7. Sebban C, Mounier N, Brousse N, et al. Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood, 2006, 108: 2540-2544.
- 8. Deconinck E, Foussard C, Milpied N, et al. High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma:a randomized multicenter study by GOELAMS.Blood, 2005, 105: 3817-3823.
- 9. Lenz G, Dreyling M, Schiegnitz E, et al. Myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission prolongs progression-free survival in follicular lymphoma: results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group. Blood, 2004, 104: 2667-2674.
- 10. Ladetto M, Marco FD, Benedetti F, et al. Prospective, multicenter randomized GITMO/IIL trial comparing intensive (R-HDS) versus conventional (CHOP-R) chemoimmunotherapy in high-risk follicular lymphoma at diagnosis: the superior disease control of R-HDS does not translate into an overall survival advantage. Blood, 2008, 111: 4004-4013.
