1. ¹Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
2. ²Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
3. ³Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

Correspondence: Dr AK Gopal, Division of Medical Oncology, Department of Medicine, University of Washington/Seattle Cancer Care Alliance, 825 Eastlake Ave E., G6-800, Seattle, WA 98109, USA. E-mail: agopal@u.washington.edu

Received 5 February 2007; Revised 13 August 2007; Accepted 19 August 2007; Published online 8 October 2007.

Abstract

The impact of the follicular lymphoma (FL) histologic grade on outcomes after high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) is unknown. We evaluated 219 consecutive patients with grades 1–3 FL who underwent HDT and ASCT at our center. Overall survival (OS), progression-free survival (PFS), relapse and non-relapse mortality (NRM) was estimated for each grade after controlling for other predictive factors. The number of patients with grades 1, 2 and 3 FL was 106 (48%), 75 (34%) and 38 (17%), respectively. Five-year outcome estimates for the entire cohort included 60% OS, 39% PFS and 46% relapse (median follow-up=7.8 years). PFS and relapse were nearly identical among patients with grade 3 FL versus grades 1–2 FL after adjusting for other contributing factors (hazard ratio (HR)=0.90, P=0.68; HR=1.07, P=0.80, respectively). The hazard for mortality (HR=0.70, P=0.23) and NRM (HR=0.33, P=0.07) was non-significantly lower among patients with grade 3 FL compared to patients with grades 1–2 disease. Factors associated with inferior PFS included elevated lactate dehydrogenase (HR=1.52, P=0.03), chemoresistance (HR=1.82, P=0.02), 2 prior therapies (HR=1.8, P=0.03) and prior radiation (HR=1.99, P=0.003). These data suggest that the histologic grade of FL does not impact PFS or relapse following HDT and ASCT.