Autologous marrow and/or blood cell transplantation (abmt) for follicular large cell lymphoma (flc)

In the working formulation folucular lymphomas are divided into three categories, small, mixed and large cell, depending on the number of large cells present. FLC lymphoma is categorized as intermediate grade implying curability. However, as the distinction between mixed and large cell lymphoma is often arbitrary, and presence of BCL-2 gene rearrangement is typical in all subtypes they are categorized as one disease with different grades in the REAL classification. In order to assess the role of intensive therapy and autotransplant for this group, we evaluated the outcome of 15 patients (pts) with FLC referred between 12/88 to 4/96. ABMT was performed in 11 pts with a median age of 41 yrs (range 30-53 yrs). Four were not transplanted (one due to progressive disease). All were given VP-16 (60 rng/kg), Melphalan (160 - 180 mg/kg) and TBI (1200 cGy) prior to reinfusion of marrow (n - 7), blood cells (n = 2) or both (n = 2), No autograft purging was performed. The disease status at time of BMT was CR1 in 5, CR2 in 2 and PR in 4. A median of 3 cycles of salvage chemotherapy was given prior to intensive therapy and ABMT. Median time from diagnosis to ABMT was 28 mo. Two patients died of regimen related causes. Median follow-up was 33 mo. Overall survival was 48% (± 17%) and relapse free survival was 11% (± 11%) at 4 years. Seven pts relapsed at a median of 10 mo after ABMT, with 2 relapses beyond 2 years. Median survival from relapse is 7 rnths (range 0-30 mo). In contrast, ABMT for diffuse large cell lymphoma at our institution (n = 46) shows a disease-free survival plateau of 42%, a median time to relapse of 4,5 mo and only 1 of 16 relapses occurring beyond 2 years. Median survival from relapse is 1.8 mo (range 0.4 - 49+ mo). We conclude that the relapse rate of FLC is high following ABMT with little evidence of a plateau. Despite this many patients have prolonged survival after relapse.