Autologous Bone Marrow Transplantation - Blog Science Connections

286 ABMT Timing in Lymphoma
abdominal disease, or serum LDH level >500 Cl/ml) treated on previous
MSKCC protocols. Patients in the historical control group received CHOP
(cyclophosphamide, doxorubicin, vincristine, prednisone) combination
chemotherapy or its variants (6,14,15). The median survival for the historical
control group was 12.8 months (because the majority of patients are alive in
group 1, the median survival for group 1 cannot be determined at this time).
There have been no late complications (1 year postdiagnosis) in this group of
patients. The results of ABMT performed in relapse are shown in Table 1
(group 2); all six patients have died, two of pulmonary hemorrhage and
peritransplant complications, one of fungal infection, and one died of
complications related to chronic thrombotic episodes experienced before
ABMT. Two patients had lymphoma progression and died at 10 and 5.2
months after transplantation.
Eleven additional patients were referred to us for ABMT after other
protocols had failed. Eight of these patients had trials on two or more drug
combinations before referral for ABMT. Bone marrow was harvested, and
depending on the patient's clinical status, one or two cycles of CHOP or other
combination chemotherapy were given in attempts to reduce disease prior to
ABMT. All patients responded to intensive therapy followed by ABMT, but
one patient died soon after transplantation of complications caused by
superior vena cava obstruction, which was present before ABMT. Six patients
have relapsed and died 1.4-25.5 months after ABMT (Table 2), and the other
four patients are alive 17.6+-45.6+ months after ABMT (Table 2).
Among the 31 patients undergoing transplantation, 14 had signs of
marrow involvement at presentation (Tables 1 and 2), and these patients
received 4-HC-purged bone marrow. Eight of these patients relapsed with
disease in an area where it had been previously detected, including the bone
marrow (three of the eight). Seventeen patients received unpurged bone
marrow; four relapsed with disease found in previous sites or sites contiguous
to them. One patient (no. 29) had marrow involvement with lymphoma at
autopsy. These patients received TBI and chemotherapy doses known to
cause aplasia in allogeneic BMT (24-26). The number of marrow mononuclear
cells infused per kilogram of body weight is shown in Table 3, as are the
number of days before the WBC count increased to over 1000/mm 3 , the
absolute neutrophil count increased to over 500/mm 3 , and the platelets
increased to over 50,000/mm 3 .
DISCUSSION
There have been several previous reports describing the long-term
results of intensive chemotherapy followed by ABMT for patients with non-
Hodgkin's lymphoma (19-23). Even though most studies have demonstrated
a significant CR rate, only a small fraction of patients in previous trials attained
a long-term benefit from the aggressive treatment. In recent ABMT trials,