• L Arcaini, F Montanari, E P Alessandrino, A Tucci, E Brusamolino, L Gargantini, R Cairoli, P Bernasconi, F Passamonti, M Bonfichi, V Zoli, C Bottelli, S Calatroni, D Troletti, M Merli, C Pascutto, I Majolino, G Rossi, E Morra, and M Lazzarino.
• Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia. Electronic address: luca.arcaini@unipv.it.
• Ann. Oncol. 2008 Jul 1; 19 (7): 1331-1335.

BackgroundTo 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 MethodsSixty-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.ResultsAt 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 x 10(6)/kg. Of 33 PCR-informative patients, the harvests resulted in PCR- 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%.ConclusionThis 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.

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