Autologous Bone Marrow Transplantation - Blog Science Connections

BMT in Relapsed Diffuse Large Cell Lymphoma 273
now demonstrated that patients with tumors that still respond to chemotherapy
after relapse are much more likely to achieve long-term disease-free
survival than are patients with resistant relapse or primarily refractory disease.
In fact, patients with lymphomas who have never achieved a complete
remission appear to be poor candidates for this treatment approach, with no
long-term survivors in two fairly large series (T. Philip, unpublished data; 4).
The second group of disease-related prognostic factors are those that reflect
tumor bulk. In a large retrospective international study (T. Philip, unpublished
data) of patients with relapsed aggressive non-Hodgkin's lymphomas, there
were no long-term survivors in patients with tumors greater than 10 cm in
diameter or lactate dehydrogenase levels of greater than twice normal at the
time of transplantation. However, these factors were related to tumor
responsiveness, and in a multivariate analysis were not found to have
independent prognostic significance.
CONCLUSIONS
When only good-risk patients (i.e., age < 60 years, high performance
status, and responsive disease after complete remission or near-complete
remission with salvage chemotherapy at traditional doses) are treated, the
results with high-dose therapy and ABMT are excellent. In 54 such patients
treated at the Dana-Farber Cancer Institute (35 patients) (4) or as part of a
retrospective international study (19 patients) (T. Philip, unpublished data),
all of the patients were in complete remission at the completion of therapy,
and the 2-year disease-free survival was 55-60%. However, if high-dose
therapy and ABMT are confined to such patients, only a minimal number of
the total group of patients with diffuse large cell lymphoma will benefit. If one
accepts the estimates for the proportion of patients with diffuse large cell
lymphoma relapsing from complete remission (25%), those being younger
than 60 years of age (40%), those having tumor that is chemotherapy
sensitive at relapse (50%), and those not having other health problems who
would ordinarily be excluded from transplantation (75%), only 4% of all
patients with diffuse large cell lymphoma would be candidates for this
therapy. For ABMT to have an important impact on the management of
diffuse large cell lymphoma, the treatment must be available to more
patients. The most likely way to accomplish this will be to treat patients early
in the course of their disease. When they can be identified, patients at
particularly high risk of relapse should undergo transplantation in first
complete remission. Patients who respond slowly to chemotherapy given in
traditional doses (i.e., not in complete remission by the third treatment cycle)
and patients who do not achieve an initial complete remission should be
considered for transplantation immediately while their tumors are still
responsive to therapy. Finally, good-risk patients who achieve a complete
remission should undergo transplantation at relapse and not after having