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Figure 67.3 Overall survival (OS) and progression-free survival (PFS) of 50 patients with transformed follicular low-grade NHL following high-dose therapy and autologous hematopoietic stem cell transplantation. (Reprinted from Ref. 87)

by autologous stem cell transplantation.88 Patients with transformed lymphomas have been included in this trial.

Results of autologous hematopoietic stem cell transplantation in series examining transformed lymphomas are displayed in Table 67.3. These results show that transplantation can be accomplished with low transplant-related mortality and that prolonged disease-free survival can be observed. Nevertheless, it is not clear in some series that there is a plateau in progression-free survival following transplantation, and it is unknown whether patients are cured.77,79,83-87 In addition, myelodysplastic syndromes, acute myeloge-nous leukemia, and second malignancies have been reported following autologous transplantation for transformed lymphomas.85-87 Of interest is the fact that some patients have relapsed with follicular histology following autologous stem cell transplanta-tion.77,84,87

Prognostic factors following autologous transplantation for transformed lymphomas have not been well characterized. The group from Dana-Farber Cancer Institute noted that 5-year overall survival following transplant was estimated at 80% for patients who underwent histologic transformation within 18 months of diagnosis, as compared with 31% for those with late transformation (P = 0.04).85 The European analysis showed inferior progression-free survival following transplant for transformed lymphoma in patients with an elevated LDH level (P = 0.0031) and those with chemotherapy-resistant disease (P = 0.04 78).87 Age above 60 years has also been associated with inferior transplant outcome for transformed lymphoma.86

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