Early pulmonary recurrence of non-Hodgkin's lymphoma after autologous marrow transplantation: evidence for reinfusion of lymphoma cells?
Disease recurrence is a major cause of failure after autologous bone marrow transplantation for Hodgkin's disease or non-Hodgkin's lymphoma. Relapse usually occurs at sites of previous involvement. The patient described here died of massive pulmonary involvement with Ki-1 antigen (CD30)-positive immunoblastic lymphoma 2 months after transplantation with unpurged autologous marrow. This relapse in a previously uninvolved organ prompted resectioning of the pre-storage marrow biopsy and resulted in identification of one small aggregation of malignant cells. A review of open lung biopsies and necropsies of autologous marrow recipients treated in Seattle identified no other patients with pulmonary malignancy who lacking previous lung tumor or evidence of contiguous pulmonary and mediastinal involvement. These observations raise questions about the assessment of pre-harvest marrow involvement and the need for marrow purging. This case also suggests that organ and tissue localization of malignant cells may be determined by abnormally expressed 'homing' ligands.
Rossetti
F
F
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA 98104, USA.
Deeg
H J
HJ
Hackman
R C
RC
D000293:Adolescent; D016026:Bone Marrow Transplantation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology* / Q000473:pathology / Q000556:secondary / Q000628:therapy; D017728:Lymphoma, Large-Cell, Anaplastic / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D009366:Neoplasm Seeding; D012008:Recurrence; D014182:Transplantation, Autologous