title: Long-term survival after autologous bone marrow transplantation for follicular lymphoma in first remission.
abstract: The role of autologous stem cell transplantation (ASCT) in the treatment of follicular lymphoma is still being defined in the era of antibody therapy. Here we report the long-term 12-year clinical outcomes of patients treated with autologous bone marrow transplantation (ABMT) for follicular non-Hodgkin's lymphoma (NHL) in first remission. Between 1988 and 1993, advanced-stage follicular NHL patients in need of initial therapy were enrolled in 2 consecutive prospective treatment trials of either standard-dose CHOP induction (83 patients) or high-dose CHOP plus granulocyte-colony stimulating factor (G-CSF) (20 patients). Patients who achieved an adequate remission with induction therapy underwent conditioning with cyclophosphamide and total body irradiation (TBI) followed by ABMT in first remission using bone marrow (BM) purged in vitro with anti-B cell monoclonal antibodies and rabbit complement (96 patients). At 12-year follow-up, 61% of the patients are alive and 43% remain in continuing complete remission. The only predictors of decreased progression-free survival proved to be histologic BM involvement at time of harvest (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.3-3.9, P<.004) and PCR detectable disease in the BM product after purging (HR 4.18, 95% CI 1.99-8.8, P=.0002). No significant predictors of overall survival were identified. These results at 12-year follow-up suggest that a subset of follicular lymphoma patients can experience prolonged survival with ABMT in first remission.
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors: Jennifer R
authors: JR
authors: Brown
authors: Yang
authors: Y
authors: Feng
authors: John G
authors: JG
authors: Gribben
authors: Donna
authors: D
authors: Neuberg
authors: David C
authors: DC
authors: Fisher
authors: Peter
authors: P
authors: Mauch
authors: Lee M
authors: LM
authors: Nadler
authors: Arnold S
authors: AS
authors: Freedman
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016465:Bone Marrow Purging / Q000379:methods; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
references: N Engl J Med. 1997 Mar 27;336(13):897-904
references: 9070469
references: Blood. 1996 Oct 1;88(7):2780-6
references: 8839876
references: Blood. 1997 Dec 15;90(12):4996-5001
references: 9389719
references: Blood. 1998 Sep 15;92(6):1933-40
references: 9731050
references: J Clin Oncol. 1999 Oct;17(10):3128-35
references: 10506609
references: Br J Haematol. 1999 Sep;106(4):1020-6
references: 10520006
references: N Engl J Med. 2004 Nov 18;351(21):2159-69
references: 15548776
references: Blood. 2004 Dec 15;104(13):3865-71
references: 15304395
references: J Clin Oncol. 2004 Dec 15;22(24):4926-33
references: 15611507
references: Blood. 2005 Feb 15;105(4):1417-23
references: 15494430
references: J Clin Oncol. 2005 Apr 1;23(10):2208-14
references: 15753460
references: Blood. 2005 May 15;105(10):3817-23
references: 15687232
references: Blood. 2005 Jun 1;105(11):4215-22
references: 15701723
references: Blood. 2005 Dec 1;106(12):3725-32
references: 16123223
references: Blood. 2006 Sep 1;108(5):1504-8
references: 16690968
references: Blood. 2006 Oct 15;108(8):2540-4
references: 16835383
references: Blood. 2006 Dec 15;108(13):4003-8
references: 16946304
references: Blood. 2000 Mar 1;95(5):1588-93
references: 10688812
references: Leukemia. 2002 Sep;16(9):1673-9
references: 12200680
references: J Clin Oncol. 2003 Mar 1;21(5):897-906
references: 12610191
references: Bone Marrow Transplant. 2003 Aug;32(3):317-24
references: 12858205
references: Bone Marrow Transplant. 2003 Nov;32(9):915-23
references: 14561993
references: J Clin Oncol. 2003 Nov 1;21(21):3918-27
references: 14517188
references: J Clin Oncol. 2004 Jun 15;22(12):2419-23
references: 15197204
references: Blood. 2004 Sep 1;104(5):1258-65
references: 15126323
references: Cancer Chemother Rep. 1966 Mar;50(3):163-70
references: 5910392
references: J Clin Oncol. 1990 May;8(5):784-91
references: 2332768
references: N Engl J Med. 1991 Nov 28;325(22):1525-33
references: 1944436
references: Blood. 1994 Jun 15;83(12):3780-6
references: 8204897
references: J Clin Oncol. 1994 Dec;12(12):2527-34
references: 7989926
references: J Clin Oncol. 1995 Dec;13(12):2916-23
references: 8523055
references: Blood. 1997 Nov 15;90(10):4201-5
references: 9354692