Autologous Bone Marrow Transplantation - Blog Science Connections

Non-Hodgkin's Lymphoma
S. Gulati and F. Cabanillas, Chairmen
DR. C. GORIN: 1 would first like to ask Dr. B. Barlogie about the quality
of the marrow harvested for transplantation. My suspicion would be that this
marrow is very poor since the marrow of his patients was heavily treated in the
past. Second, I would like to know the degree of plasma cell contamination.
Third, do you consider treating the marrow in vitro before infusion, or do you
consider collection of peripheral blood stem cells?
DR. B. BARLOGIE: In response to the third question—first, I think we like
to establish a baseline, no purging initially. This is based on the limited
experience in this advanced stage of the disease, particularly in the one
patient who had 30% tumor cells. She remains in bone marrow remission 14
months after harvest. The serum protein is still declining and is less than
0.5 g%. The quality of the marrow was initially poor. Many of these patients
had a long-term disease history, from 2 to more than 6 years. One of the
patients who received an allogeneic transplant is one of our longer survivors,
with a history of more than 10 years. The VAD regimen, which is not very
marrow toxic at all, is usually the induction regimen given before harvesting.
In the group of patients who did not receive total body irradiation, but just
melphalan, the marrow quality was much poorer than in the more recent
patients.
With regard to the treatment strategy, I believe that when one looks at the
prognostic factors in terms of achieving good remission with high dose
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