• Rui Lyu, Tingyu Wang, Dehui Zou, Wei Liu, Shuhua Yi, Wenyang Huang, Gang An, Yan Xu, Zengjun Li, and Lugui Qiu.
• State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
• Medicine (Baltimore). 2020 May 29; 99 (22): e20395.

RationaleAutologous stem cell transplantation (ASCT) is not routinely recommended as first-line choice for follicular lymphoma (FL). However, we actually have observed that young patients with extremely high-risk factors benefit from ASCT. This study aims to speculate the rationality of ASCT as first-line treatment, through 3 cases and review of the literature.Patient Concerns3 young-adult patients with FL received ASCT as first-line treatment.DiagnosisAll the 3 patients were no more than 30 years old and the diagnosis of FL was confirmed by histopathological and immunohistochemical evaluations. They all had multi-organ involvements, and two of them presented with a "leukemic-like" manifestation. Compared with those in the previous literatures, the 3 patients were relatively younger and had more invasive clinical features.InterventionsThe 3 patients received combined chemotherapy plus rituximab, followed by first-line ASCT.OutcomesAll the 3 patients got complete remission and minimal residual disease negativity after ASCT, The median follow-up time was 109 (97-117) months, and all of them were in remission more than 8 years after transplant.LessonsGuidelines for FL are mainly based on elderly patients, but are not suitable enough for all, especially for the young FL patients. For young patients with certain high-risk FL, first-line ASCT does not go against the guidelines, and should be recommended individually.

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