***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE To assess myeloablative therapy with autologous bone marrow transplantation ( ABMT ) in younger patients with follicular lymphoma in the hope of prolonging remission duration and survival . PATIENTS AND METHODS Since June 1985 , 64 patients with follicular lymphoma have received cyclophosphamide ( CY ) 60 mg/kg x 2 and total-body irradiation ( TBI ) 2 Gy x 6 supported by ABMT as consolidation of second or subsequent remission . The marrow mononuclear cell ( MNC ) fraction was treated in vitro with three cycles of the monoclonal antibody ( MAb ) anti-CD20 and baby rabbit complement before cryopreservation . At the time of treatment , 34 patients were in complete remission ( CR ) , and 30 had residual disease present . RESULTS The median time to engraftment was 28 days ( range , 15 to 46 ) for both a neutrophil count greater than 0.5 x 10(9)/L and a platelet count greater than 20 x 10(9)/L. Engraftment did not occur in one patient who died at 12 weeks , and three patients ( excluded from the range ) have had delayed recovery ( > 6 months ) of RBCs and platelets . Fifty two patients are alive ; three died as a consequence of the transplant procedure , two died in remission from other causes , and seven died of recurrent lymphoma . There was a significant correlation between survival and the total number of episodes of treatment required during the course of the illness ( < or = to three v > three , P = .01 ) . With a median follow-up duration of 3 1/2 years , 35 patients continue in remission between 1 and 8 years , and 24 have developed recurrent lymphoma , five with evidence of transformation to high- grade histology . Freedom from recurrence did not correlate with the time from diagnosis , the number of previous treatments , the presence or absence of residual disease at the time of treatment , or during which specific remission the treatment was given ( second v > second ) . However , comparison with an age-matched , remission-matched , historical control group shows a significant advantage in favor of treatment with CY plus TBI plus ABMT ( P = .001 ) ; currently , there is no difference in survival . CONCLUSION These results are encouraging , although preliminary ; it remains to be established whether this treatment prolongs survival Phase 2 studies suggest that the monoclonal antibody rituximab may improve the prognosis of patients with follicular lymphoma ( FL ) when it is added to chemotherapy . In the current study , 428 patients with untreated , advanced-stage FL were r and omly assigned for therapy with cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) alone ( n = 205 ) or CHOP combined with rituximab ( R-CHOP ) ( n = 223 ) . R-CHOP reduced the relative risk for treatment failure by 60 % and significantly prolonged the time to treatment failure ( P < .001 ) . In addition , a significantly higher overall response rate ( 96 % vs 90 % ; P = .011 ) and a prolonged duration of remission ( P = .001 ) were achieved . In spite of a relatively short observation time , these beneficial effects even translated to superior overall survival ( P = .016 ) , with 6 deaths in the R-CHOP group compared with 17 deaths in the CHOP group within the first 3 years . The predominant treatment-related adverse effect was myelosuppression . Severe granulocytopenia was more frequently observed after R-CHOP ( 63 % vs 53 % ; P = .01 ) . However , severe infections were rare and of similar frequency after R-CHOP and CHOP ( 5 % and 7 % ) . Hence , adding rituximab to CHOP significantly improves the outcome for patients with previously untreated advanced-stage FL and does not induce major adverse effects Nonmyeloablative stem cell transplantation in patients with follicular lymphoma has been design ed to exploit the graft-versus-lymphoma immunity . The long-term effectiveness and toxicity of this strategy , however , is unknown . In this prospect i ve study , we analyzed our 8-year experience . Patients received a conditioning regimen of fludarabine ( 30 mg/m(2 ) daily for 3 days ) , cyclophosphamide ( 750 mg/m(2 ) daily for 3 days ) , and rituximab ( 375 mg/m(2 ) for 1 day plus 1000 mg/m(2 ) for 3 days ) . They were then given an infusion of human leukocyte antigen-matched hematopoietic cells from related ( n = 45 ) or unrelated donors ( n = 2 ) . Tacrolimus and methotrexate were used for graft-versus-host disease ( GVHD ) prophylaxis . Forty-seven patients were included . All patients experienced complete remission , with only 2 relapses . With a median follow-up time of 60 months ( range , 19 - 94 ) , the estimated survival and progression-free survival rates were 85 % and 83 % , respectively . All 18 patients who were tested and had evidence of  JH/bcl-2 fusion transcripts in the bone marrow at study entry experienced continuous molecular remission . The incidence of grade 2-IV acute GVHD was 11 % . Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up . We believe that the described results are a step forward toward developing a curative strategy for recurrent follicular lymphoma BACKGROUND We compared a regimen of six chemotherapeutic agents administered sequentially at high doses , followed by myeloablative treatment and bone marrow transplantation , with a regimen of methotrexate , doxorubicin , cyclophosphamide , vincristine , prednisone , and bleomycin ( MACOP-B ) as initial or salvage treatment for adults with diffuse large-cell lymphoma . METHODS Ninety-eight eligible patients with diffuse large-cell lymphoma of the B-cell type were r and omly assigned to receive either MACOP-B ( 50 patients ) or high-dose sequential therapy ( 48 patients ) . The study design allowed for patients in whom the assigned treatment failed to cross over to the other treatment group . RESULTS After a median follow-up of 55 months , the patients given high-dose sequential therapy , as compared with those treated with MACOP-B , had significantly higher rates of complete response ( 96 percent vs. 70 percent , P=0.001 ) , freedom from disease progression ( 84 percent vs. 49 percent , P<0.001 ) , freedom from relapse ( 88 percent vs. 70 percent , P=0.055 ) , and event-free survival ( 76 percent vs. 49 percent , P=0.004 ) . The difference in overall survival at seven years , which also favored the group assigned to high-dose sequential therapy , was marginally significant ( 81 percent vs. 55 percent , P=0.09 ) . CONCLUSIONS High-dose sequential therapy is superior to st and ard-dose MACOP-B for patients with diffuse large-cell lymphoma of the B-cell type Myeloablative radio-chemotherapy with subsequent autologous stem cell transplantation ( ASCT ) significantly prolongs progression free and probably overall survival in follicular lymphoma ( FL ) in first remission . The current trial explored prospect ively the rate of successful stem cell mobilization in patients with advanced stage FL after initial therapy with either Mitoxantrone , Chlorambucil , Prednisone ( MCP ) or Cyclophosphamide , Doxorubicin , Vincristine , Prednisone ( CHOP ) as part of a prospect i ve r and omized comparison of both regimens . ASCT patients received Dexa-BEAM ( Dexamethasone , BCNU , Melphalan , Etoposide , Cytarabine ) for mobilization of stem cells . Stem cells were collected and a minimum of 2x2.0x106/kg bw CD34 + was required for ASCT . Of 79 evaluable patients , 58 ( 73 % ) had follicular lymphoma , 13 ( 16 % ) mantle cell lymphoma and 8 ( 10 % ) lymphoplasmacytic lymphoma . In the 45 patients assigned to CHOP , stem cell collection was successful in 42 cases ( 93 % , 95 % CI 82 % to 99 % ) . This high mobilization rate after CHOP could be confirmed in 61 subsequent patients ( 87 % ) . In contrast , after MCP therapy stem cell collection was successful in only 15 of 34 patients ( 44 % , 95 % CI 27 % to 62 % ; P=0.0003 ) . In conclusion , initial therapy with MCP significantly impairs the ability to collect stem cells and should be avoided for first line therapy of younger patients potentially qualifying for high dose consolidation and ASCT in first remission We evaluated the role of rituximab ( R ) both in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma ( FL ) . A total of 465 patients were r and omized to induction with 6 cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) ( every 3 weeks ) or R-CHOP ( R : 375 mg/m(2 ) intravenously , day 1 ) . Those in complete remission ( CR ) or partial remission ( PR ) were r and omized to maintenance with R ( 375 mg/m(2 ) intravenously once every 3 months for a maximum of 2 years ) or observation . R-CHOP induction yielded an increased overall response rate ( CHOP , 72.3 % ; R-CHOP , 85.1 % ; P < .001 ) and CR rate ( CHOP , 15.6 % ; R-CHOP , 29.5 % ; P < .001 ) . Median progression-free survival ( PFS ) from first r and omization was 20.2 months after CHOP versus 33.1 months after R-CHOP ( hazard ratio [ HR ] , 0.65 ; P < .001 ) . Rituximab maintenance yielded a median PFS from second r and omization of 51.5 months versus 14.9 months with observation ( HR , 0.40 ; P < .001 ) . Improved PFS was found both after induction with CHOP ( HR , 0.30 ; P < .001 ) and R-CHOP ( HR , 0.54 ; P = .004 ) . R maintenance also improved overall survival from second r and omization : 85 % at 3 years versus 77 % with observation ( HR , 0.52 ; P = .011 ) . This is the first trial showing that in relapsed/resistant FL rituximab maintenance considerably improves PFS not only after CHOP but also after R-CHOP induction In this r and omized multicenter study of 136 patients , 6 courses of CHOP ( cyclo-phosphamide/doxorubicin/vincristine/prednisone ) followed by rituximab ( CHOP-R ) were compared with rituximab-supplemented high-dose sequential chemotherapy with autografting ( R-HDS ) to assess the value of intensified chemo-therapy as a first-line treatment for high-risk follicular lymphoma ( FL ) after the introduction of monoclonal antibodies . The analysis was intention to treat with event-free survival ( EFS ) as the primary endpoint . Complete remission ( CR ) was 62 % with CHOP-R and 85 % with R-HDS ( P < .001 ) . At a median follow-up ( MFU ) of 51 months , the 4-year EFS was 28 % and 61 % , respectively ( P < .001 ) , with no difference in overall survival ( OS ) . Molecular remission ( MR ) was achieved in 44 % of CHOP-R and 80 % of R-HDS patients ( P < .001 ) , and was the strongest independent outcome predictor . Patients relapsing after CHOP-R underwent salvage R-HDS in 71 % of cases . Salvage R-HDS had an 85 % CR rate and a 68 % 3-year EFS ( MFU , 30 months ) . We conclude that ( 1 ) achieving MR is critical for effective disease control , regardless of which treatment is used ; ( 2 ) R-HDS ensures superior disease control and molecular outcome than CHOP-R , but no OS improvement ; and ( 3 ) CHOP-R failures have a good outcome after salvage R-HDS , suggesting that relapsed/refractory FL could be the most appropriate setting for R-HDS-like treatments . This trial was registered at www . clinical trials.gov as no. NCT00435955 Conventional chemotherapy has failed to substantially prolong survival for patients with advanced follicular lymphoma . To improve outcomes , the German Low- Grade Lymphoma Study Group ( GLSG ) initiated a r and omized trial to compare the effect of potentially curative myeloablative radiochemotherapy followed by autologous stem cell transplantation ( ASCT ) with interferon-alpha ( IFN-alpha ) maintenance therapy in first remission . Three hundred seven patients ( younger than 60 years ) with follicular lymphoma were recruited into the trial from 130 institutions . After 2 cycles of cyclophosphamide-doxorubicin-vincristine-prednisone ( CHOP ) or mitoxantrone-chlorambucil- 
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AUTHORS ' CONCLUSIONS In summary , the currently available evidence suggests a strong PFS benefit for HDT + ASCT compared with chemotherapy or immuno-chemotherapy in previously untreated patients with FL .
No statistically significant differences in terms of OS , TRM and secondary cancers were detected .
Moreover , longer follow-up data are necessary to find out whether the PFS advantage will translate into an OS advantage in previously untreated patients with FL.There is evidence that HDT + ASCT is advantageous in patients with relapsed FL