Autologous Bone Marrow Transplantation - Blog Science Connections

258 ABMT in Burkitt's Lymphoma
DISCUSSION
During this 6 years of using massive therapy and ABMT, we have been
involved in the French SFOP protocol of conventional chemotherapy, which
has increased the cure rate for Burkitt's lymphoma from 42% to 77%
(2,3,5,29). At present, 100% of our patients with Burkitt's lymphoma are
included at diagnosis in the conventional regimen, but 20% still remain
candidates for ABMT. Based on an analysis of the progress achieved over
recent years with massive therapy and the new conventional regimen, we
think it is possible to draw several conclusions.
Patients with Burkitt's lymphoma who have progressive disease, relapses,
or PR after initial induction therapy are still in a group of patients whose
survival is very rare with conventional therapy (5,29). In the group of like
patients we report here, 17 of 36 survive with NED (47%). This is clearly
considerable progress for patients with Burkitt's lymphoma. The percentage
of therapy-related deaths in this group (12%) is not very different from that
associated with most modern conventional chemotherapy (29,39,40). It is
also of interest to consider all patients treated in Lyons during this period who
were potential candidates for ABMT. In our group six such patients out of 41
were not included because of early death after relapse (two), resistant relapse
on progression under rescue protocol (one), bone marrow involvement at
relapse (one), or progressive disease early after reinduction of remission
(two). If we considered this total experience of Burkitt's lymphoma, the
overall survival rate between 1980 and 1985 in Lyons for patients considered
candidates for ABMT in Burkitt's lymphoma is then 40%. The selections for
ABMT of 41 patients out of 47 with clear indications does not modify the
conclusion. In our previous experience, such a group had no survivors (3). As
previously shown, patients with Burkitt's lymphoma who stay in CR more than
8 months can be considered cured (3), and 70% of our survivors belong to this
group.
The patients with a long delay to CR were clearly patients with very poor
prognoses (2-4), but five of six such patients who were grafted are long-term
survivors. However, with the new conventional regimen, this characteristic
has disappeared and is not now an indication for ABMT in our group.
Results of treating patients with ABMT after a relapse in the CNS or
cerebrospinal fluid are encouraging: 9 of 19 are long-term survivors. The
question of whether patients experiencing these particular relapses can be
cured by conventional regimens (as patients with ALL can be) must now be
addressed.
Our very preliminary experience of massive therapy as consolidation for
initial CNS involvement in first CR is quite encouraging. The numbers are
small, but the survival of five of nine is better than the 25% survival produced
with a conventional regimen (2).
The question of the possible adverse effects of massive therapy followed
by ABMT must be considered. Two cases are of particular interest. Both had