follicular non hodgkin's l | Treatment of follicular lymphoma

Treatment of follicular lymphoma


Follicular lymphoma is a malignant disease of the lymphatic system and a common type of non-Hodgkin's lymphoma. Follicular lymphoma comes from B cells, and mainly affects older people and, due to its slow growth, is considered indolent lymphoma. Follicular lymphoma develops unnoticed over a long period of time. The symptoms that can be detected are a dilation of the lymph nodes, fever, weight loss, perspiration or fatigue. It is called follicular lymphoma because the affected lymph nodes exhibit rounded structures called "follicles". Follicular lymphoma Stage classification is performed by imaging scanner, bone marrow biopsy and blood tests: Ann Arbor I and II early stages, or Ann Arbor III and IV advanced stages, which are diagnosed in most patients. Prognosis and treatment depend on the extent of the disease during the initial diagnosis. The small number of patients in stages I or II can be cured by radiation therapy. In advanced stages III or IV, patients are considered incurable. Chemotherapy combined with the rituximab monoclonal antibody is the current therapeutic strategy for symptomatic patients at an advanced stage. High-dose treatment with self-grafting of stem cells (i.e., from the patient itself) is known for its positive effects in patients at advanced stages, particularly for the progression-free survival criterion. However, this treatment option could have more late side effects related to treatment than chemotherapy, including secondary malignant tumors.

Based on this hypothesis, we evaluated the role of high-dose treatment followed by the autografting of stem cells in the treatment of follicular lymphoma in adults. We have included in the main analyses five trials totaling 1 093 patients. The result of meta-analyses for patients not previously treated (four trials) was that no statistically significant difference in survival, treatment-related mortality or secondary malignant tumours occurred between Patients who received high-dose treatment followed by autografting of stem cells and those treated by chemotherapy alone. However, progression-free survival (tumor control) was significantly better with high-dose chemotherapy followed by stem cell grafting. Adverse events are more common in patients receiving high-dose therapy followed by autografting of stem cells.

High-dose chemotherapy with stem cell transplantation has an advantage for patients who are victims of relapse, both in terms of survival and tumor control (one trial). This test does not show any adverse reaction data.

Authors ' Conclusions: In summary, the data currently available suggest a strong SSP-level advantage for THD + GATS in relation to chemotherapy or immuno-chemotherapy, in patients with LF not previously treated. No statistically significant differences were found in terms of SG, TRM or secondary cancers. These effects are confirmed in the analysis of the subgroup (one test) adding rituximab to the two treatment groups. Other trials evaluating this approach are needed to more precisely determine this effect in the rituximab era. Furthermore, longer-term data are required to determine whether the SSP benefit will result in an advantage in Ili in patients with LF not previously treated.


There is evidence to suggest that the THD + GATS is advantageous in patients with LF recurrent.

Background: follicular lymphoma (LF) is the most common indolent lymphoma and the second most commonly known non-Hodgkin's lymphoma (NHL) in the Western world. Standard treatment usually includes rituximab and chemotherapy. High-dose (THD) treatment followed by a stem cell autotransplantation (GATS) is an option for patients at an advanced stage or as a second-line treatment; It improves survival rates without progression (SSP). However, the impact of the THD with GATS remains uncertain, given the evidence of an increased risk of secondary cancer.

Objectives: We conducted a systematic review with meta-analysis of randomized controlled trials (RCTs) comparing the THD + GATS with chemotherapy or immuno-chemotherapy in patients with LF, with respect to overall survival (SG), PHC, treatment-related mortality (TRM), adverse events and secondary malignant tumours.

Documentary research strategy: We searched for RCTs in CENTRAL, MEDLINE and Embase, as well as in conference proceedings, from January 1985 to September 2011. Two authors examined the results of the research independently.

Selection criteria: Randomized controlled trials comparing chemotherapy or immuno-chemotherapy with THD followed by GATS in adults with a LF not previously treated or recurrent.

Data collection and Analysis: We used the hazard ratio (HR) as an effect measure for SG and SSP and the relative risk for response rates. Two authors extracted the data and evaluated the quality of the tests independently.

Main results: Our research strategies have led to 3 046 potentially relevant references. Of these, five rcts involving 1 093 patients were included; Four trials were carried out on patients not previously treated and a trial on recurrent patients. Overall, the quality of the five trials is considered moderate. All trials were described as randomized and judged to be open studies because, generally, trials evaluating stem cell grafts are not blind. Given the small number of studies in each analysis (four or less), the quantification of heterogeneity was unreliable and was not evaluated in detail. Uncertainties in calculating HR are a potential source of bias. For the SG, the HR had to be calculated for three Tests from the survival curves, and for two trials with respect to the SSP.

In the THD + GATS group, we found a statistically significant increase in SSP in patients suffering from LF not previously treated (HR = 0.42; confidence interval (CI) at 95% 0.33 to 0.54; P < 0.00001). However, this effect does not result in a statistically significant advantage at the SG level (HR = 0.97; 95% CI 0.76 to 1.24; P = 0.81). The sub-group of tests that added rituximab to the two intervention groups (one test) confirms these results and the test had to be interrupted prematurely after an intermediate analysis due to a statistically significant advantage at the level of The SSP in the THD + GATS Group (SSP: HR = 0.36; 95% CI 0.23 to 0.55; SG: HR = 0.88; 95% CI 0.40 to 1.92). In the four trials of previously untreated patients there are no statistically significant differences between the THD + GATS and the control group in terms of TRM (RR = 1.28; 95% CI 0.25 to 6.61; p = 0.77), secondary acute myeloid leukemia syndrome/myelodysplastic syndromes (RR = 2.87; 95% CI 0.7 to 11.75; P = 0.14) or solid cancers (RR = 1.20; 95% CI 0.25 to 5.77; P = 0.82). Adverse events were rarely reported and were more frequently observed in patients under THD + GATS (mainly infections and haematological toxicity).

For patients with LF recurrent, there is some evidence (one trial, N = 70) that the GATS THD + is advantageous in terms of SSP and SG (ssp: HR = 0.30; 95% CI 0.15 to 0.61; SG: HR = 0.40; 95% CI 0.18 to 0.89). For this test, no results were reported for the TRM, adverse events or secondary cancers.