Immunochemotherapy with in vivo purging and autotransplant induces long clinical and molecular remission in advanced relapsed and refractory follicular lymphoma

Background: To evaluate the clinical outcome of patients with relapsed or refractory follicular lymphoma treated with
immunochemotherapy, in vivo purging and high-dose therapy with autotransplant.
Patients and methods: Sixty-four patients were enrolled in the trial. Primary end point was progression-free survival
(PFS). Secondary end points were the in vivo purging effect on stem-cell harvest and the impact of molecular response
on the outcome.
Results: At enrollment, 59% of patients were PCR+ for bcl-2 rearrangement in bone marrow (PCR-informative). After
the immunochemotherapy, before mobilization, 97% obtained complete response or partial response and 87% of
patients informative for bcl-2 were molecularly negative. Sixty-one patients proceeded to in vivo purging and peripheral
blood stem cell (PBSC) mobilization with rituximab and high-dose AraC. The median number of CD34+ cells collected
was 16.6 · 106/kg. Of 33 PCR-informative patients, the harvests resulted in PCR2 in all. Fifty-eight patients received
high-dose therapy and autotransplant of in vivo purged PBSC. After a median follow-up of 3.5 years, 41 patients are in
complete remission. Five-year PFS is 59%.
Conclusion: This study demonstrates that patients with advanced relapsed or refractory follicular lymphoma treated
with immunochemotherapy, in vivo purging and autotransplant may obtain long-lasting PFS. In bcl-2-positive patients,
in vivo purging allows the harvest of lymphoma-free PBSC. Absence of the bcl-2 rearrangement after autotransplant is
associated with persistent clinical remission.