Publication: Trasplante autólogo de progenitores hematopoyéticos (TAPH) en linfoma folicular (FL). Un análisis de muy largo seguimiento de los pacientes incluidos en el registro español Geltamo centrado en su eficacia y en la posibilidad de curación
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2016-07-18
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Universidad Complutense de Madrid
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Abstract
Los pacientes con LF presentan un curso clínico indolente y una supervivencia relativamente prolongada, sin embargo el LF continúa considerándose una enfermedad incurable con los tratamientos convencionales y la recaída de los pacientes es la norma, alcanzando en las sucesivas recaídas un menor número de respuestas y de menor duración. Los enfermos con LF de alto riesgo intensificados con TAPH pueden alcanzar remisiones prolongadas, pero el mejor momento para dicho procedimiento es controvertido. Los enfermos trasplantados en primera remisión han demostrado un beneficio en la Supervivencia Libre de Progresión (SLP) en comparación con los tratados con la terapia convencional o con la inmunoquimioterapia. Sin embargo, ningún estudio randomizado (ER) ha demostrado todavía un beneficio en la Supervivencia Global (SG). No obstante, la mediana de seguimiento de los estudios fase III que evalúan el papel del TAPH es insuficiente para obtener beneficios en términos de SG. El único ER disponible que evalúa el rol del TAPH en pacientes con LF trasplantados en 2ª RC demuestra un beneficio en la SLP y la SG en comparación con la terapia convencional y ha sido confirmado en varios estudios retrospectivos con largos seguimientos...
Patients with FL typically have indolent courses and relatively long median survival, but this disease remains incurable with conventional chemotherapy; relapse is expected and, as the tumor becomes less responsive to subsequent lines of treatment, remissions become shorter. High-risk FL patients intensified with HDT/ASCT may achieve prolonged remissions. The best timing for the procedure remains controversial. Patients who are transplanted in first remission show a Progression Free Survival (PFS) advantage compared to those treated with conventional chemotherapy or inmunochemoterapy. Nevertheless, no randomized studies have yet shown an overall survival (OS) benefit in this setting. However, the follow-up time of the phase III trials testing HDT/ASCT is insufficient to reach an OS advantage. The only available randomized control trial (RCT) evaluating the role of HDT/ASCT in FL patients in second remission demonstrated a PFS and OS advantage as compared with conventional therapy, and was confirmed in some long-term follow-up retrospective studies. Addition of rituximab to conventional therapy has brought a significant development, with several phase III trials proving a benefit in favor of rituximab-containing chemotherapy upfront, however the vast majority of studies of HDT/ASCT in FL have been performed in the pre-rituximab era and its value now remains to be elucidated...
Patients with FL typically have indolent courses and relatively long median survival, but this disease remains incurable with conventional chemotherapy; relapse is expected and, as the tumor becomes less responsive to subsequent lines of treatment, remissions become shorter. High-risk FL patients intensified with HDT/ASCT may achieve prolonged remissions. The best timing for the procedure remains controversial. Patients who are transplanted in first remission show a Progression Free Survival (PFS) advantage compared to those treated with conventional chemotherapy or inmunochemoterapy. Nevertheless, no randomized studies have yet shown an overall survival (OS) benefit in this setting. However, the follow-up time of the phase III trials testing HDT/ASCT is insufficient to reach an OS advantage. The only available randomized control trial (RCT) evaluating the role of HDT/ASCT in FL patients in second remission demonstrated a PFS and OS advantage as compared with conventional therapy, and was confirmed in some long-term follow-up retrospective studies. Addition of rituximab to conventional therapy has brought a significant development, with several phase III trials proving a benefit in favor of rituximab-containing chemotherapy upfront, however the vast majority of studies of HDT/ASCT in FL have been performed in the pre-rituximab era and its value now remains to be elucidated...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 17/12/2015