Page 21 - Wondergem

RS=retrospective, P=prospective 1 U=up-front/1st line treatment for TFL,
R=relapse/2nd line treatment for TFL
R=rituximab RC=R-chemo
ng= not given for transformed lymphoma patients
n/a = not applicable
for transplants: remission rates are after transplant unless mentioned otherwise ORR=overall response rate, CR=complete remission, PR= partial remission OS=overall survival, med=median, m=months
Treatment options for transformed lymphoma
Rituximab-chemotherapy
The introduction of rituximab to TFL therapy significantly improved OS, with median survival up to 50 months; a major improvement considering the historically poor prognosisof0.7-2.7years.ThebackboneofrituximabtherapyinTFLisusuallyCHOP, or in patients already treated with anthracyclines, regimens containing either high dose cytarabine or cisplatinum or topoisomerase II inhibitors in combination with alkylating therapy. Rituximab appears especially effective if patients are rituximab naïve at transformation (101).
Consolidation therapy
Although the use of rituximab in combination with the drugs described above is generally accepted in TFL, the use of up-front autologous or even allogeneic SCT following the achievement of complete remission is currently not clear. In contrast, in patients not reaching CR after induction chemotherapy, being described in up to 30-40% of patients (77,87), the only chance of long term survival is when re-induction therapy results in a sufficient response to allow consolidation with a salvage SCT. The absence of long term survival of patients refractory to induction and salvage chemotherapy (9,20,chapter 4) demonstrates the urgent need for therapies other than rituximab and/or chemotherapy or radiotherapy (see “other treatments” below).
Autologous SCT
ASCT was introduced as a treatment for TFL in the pre-rituximab era to improve inferior outcome after chemotherapy only. Five year OS in TFL patients improved from 20- 30% after chemotherapy only to 40-60% with up-front ASCT (9,20,76,84,88,101). This prompted many centers to adopt ASCT as first line therapy for TFL.
However, the role of up-front ASCT in the rituximab era is subject of debate.
Introduction and scope of this thesis
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