Early leukemic recurrence of non-Hodgkin lymphoma after high-dose anti-neoplastic therapy with autologous marrow rescue.
Five patients with recurrent non-Hodgkin lymphoma treated with high-dose salvage anti-neoplastic therapy supported by unpurged histologically uninvolved autologous bone marrow reinfusion have suffered relapse in the blood and bone marrow within a few weeks of the marrow reinfusion. Four of these patients had the small non-cleaved (Burkitt) sub-type of malignant lymphoma. Additional risk factors for such 'leukemic relapse' appear to include a rapid clinical course prior to the salvage therapy and the presence of karyotypic subclones within the malignant cell population. It seems likely that these relapses occurred as a result of reinfusion of small numbers of viable 'marrow homing' malignant cells with the autologous bone marrow. This pattern of recurrence is rare in patients with other lymphoma sub-types receiving unpurged marrow. These data may permit exclusion of patients at high risk for this devastating relapse pattern from clinical trials of unpurged autologous marrow transplantation and the selection of patients for trials of marrow purging.
Vaughan
W P
WP
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68105.
Weisenburger
D D
DD
Sanger
W
W
Gale
R P
RP
Armitage
J O
JO
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001853:Bone Marrow / Q000473:pathology; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D003582:Cytogenetics; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007938:Leukemia / Q000139:chemically induced* / Q000235:genetics / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents