title: Long-term follow-up of autologous bone marrow transplantation in patients with relapsed follicular lymphoma.
abstract: We report the results of high-dose chemoradiotherapy and anti-B-cell monoclonal antibody-purged autologous bone marrow transplantation (ABMT) in patients with relapsed indolent follicular lymphoma. Between March 1985 and May 1995, 153 patients underwent ABMT using a uniform ablative regimen with cyclophosphamide and total body irradiation and bone marrow (BM) purging. All patients received multiple chemotherapy regimens before ABMT. At BM harvest, only 30% of patients were in complete remission, and overt BM infiltration was present in 47%. The disease-free survival (DFS) and overall survival (OS) are estimated to be 42% and 66% at 8 years, respectively. Patients whose BM was negative by polymerase chain reaction (PCR) for bcl2/IgH rearrangement after purging experienced longer freedom from recurrence than those whose BM remained PCR positive (P <.0001). Continued PCR negativity in follow-up BM samples was also strongly predictive of continued complete remission (CR). The 12-year survival from diagnosis for these 153 patients is 69%. Considering that the median survival from diagnosis and first recurrence of patients with advanced follicular lymphoma are 8 and 5 years, respectively, our results provide evidence that myeloablative therapy and ABMT may prolong overall survival.
authors.affiliation: Department of Adult Oncology and Biostatistics, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Freedman
authors.forename: D
authors.initials: D
authors.lastname: Neuberg
authors.forename: P
authors.initials: P
authors.lastname: Mauch
authors.forename: R J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: K C
authors.initials: KC
authors.lastname: Anderson
authors.forename: D C
authors.initials: DC
authors.lastname: Fisher
authors.forename: R
authors.initials: R
authors.lastname: Schlossman
authors.forename: E P
authors.initials: EP
authors.lastname: Alyea
authors.forename: T
authors.initials: T
authors.lastname: Takvorian
authors.forename: H
authors.initials: H
authors.lastname: Jallow
authors.forename: C
authors.initials: C
authors.lastname: Kuhlman
authors.forename: J
authors.initials: J
authors.lastname: Ritz
authors.forename: L M
authors.initials: LM
authors.lastname: Nadler
authors.forename: J G
authors.initials: JG
authors.lastname: Gribben
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008224:Lymphoma, Follicular / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics; D012008:Recurrence; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019253:Proto-Oncogene Proteins c-bcl-2; D003520:Cyclophosphamide