Autologous Bone Marrow Transplantation - Blog Science Connections

Treatment Strategies for NHL 303
Some encouraging data from studies of small numbers of patients (42-46)
suggest a possible role for ABMT for patients who respond partially to initial
treatment. Unfortunately, in spite of relatively high response rates, high-dose
chemotherapy and ABMT do not improve survival rates for patients with PRD.
To retrospectively evaluate the possible role of ABMT in PR, we collected data
on ten consecutive PR patients who were treated at Centre Leon Berard (Table
3). All patients had diffuse advanced non-Hodgkin's lymphoma (six with bulky
stage HI disease and three with stage IV disease, including two with CNS
involvement) and were initially treated by a relatively intensive regimen
(M-BACOD or LMB 01 -02) (20). Only patients with no evidence of tumor
progression during the induction phase are included. Only one patient died with
progressive disease (at 7 months). Seven of eight patients who received highdose
chemotherapy and ABMT are alive and well with a median follow-up of 24
months (range, 10-49 months). The one patient who died also underwent
ABMT but disease progressed before high-dose chemotherapy was started.
Two patients received only MIME (22) and remain disease free at 10+ and 30+
months. Of course, these are data on only 10 patients, and the mixture of adult
and pediatric patients, as well as the high proportion of patients with Burkitt's
lymphoma (3 of the 10 patients) may be criticized. Although preliminary, the
results of the Centre Leon Berard strategy for the treatment of advanced
aggressive non-Hodgkin's lymphoma prompt the following comments: First,
note that five of six of the PR patients achieved CR after switching to an
Table 3. Salvage Treatment After Partial Remission
Patient Salvage Evolution (months of
(age/sex) Treatment Response follow-up)
3/M BACT (IGR) CR CCR (34)
4/F BEAM CR CCR (10)
7/M BEAM/TBI CR CCR (12)
11/M Busulfan CR CCR (19)
Cyclophosphamide
36/M BEAM CR CCR (24)
52/M — PD Died (7)
52/F BEAM CR CCR (10)
57/M BACT (IGR) CR CCR (49)
61/M MIME CR CCR (10)
70/M MIME CR CCR (30)
Abbreviations: BACT, BCNU (carmustine), ara-C (cytarabine), cyclophosphamide,
6-thioguanine (Institut Gustave-Roussy); CR, complete remission; CCR, continuous
complete remission; BEAM, BCNU (carmustine), etoposide, ara-C (cytarabine), melphalan;
TBI, total body irradiation; MIME, mitoguazone, ifosfamide, methotrexate,
etoposide.