title: Extended follow-up of autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide (4-HC) purging for indolent or transformed non-Hodgkin lymphomas.
abstract: Autologous blood or marrow transplantation (ABMT) for low-grade lymphomas can prolong event-free survival (EFS) but requires long-term follow-up. We report one of the longest follow-ups to a prospective transplantation study in such diseases. On a phase II study, 80 patients with low-grade, transformed, or mantle cell lymphoma received ABMT with 4-hydroperoxycyclophosphamide (4-HC) purging as part of initial or salvage therapy. Diagnoses included nontransformed follicular lymphoma in 63% and transformed lymphoma in 15%. With 16.6-year median follow-up for survival, actuarial 10-year EFS and overall survival (OS) were 34% (95% confidence interval [CI], 25%-46%) and 45% (35%-57%). Median EFS and OS were 3.0 and 8.0 years. Early nonrelapse mortality incidence was 8%; myelodysplastic syndrome or leukemia incidence was 4%. Most relapses occurred within 3 years, with a median time to diagnosis of relapse of 1.8 years (range: 0.1-15.6 years). On multivariate analysis, age >50 years, ≥3 prior chemotherapy regimens, and ABMT after relapse were associated with significantly inferior survival. Fifteen patients (19%) were event-free >15 years after transplantation, raising the possibility of a plateau in the progression-free survival curve. Thus, 4-HC-purged ABMT can produce extended remissions in a subgroup of patients with indolent lymphomas.
authors.affiliation: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ykasamo1@jhmi.edu
authors.forename: Yvette L
authors.initials: YL
authors.lastname: Kasamon
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Gocke
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Seifter
authors.forename: Janice M
authors.initials: JM
authors.lastname: Davis-Sproul
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002471:Cell Transformation, Neoplastic; D003520:Cyclophosphamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007938:Leukemia / Q000209:etiology; D008224:Lymphoma, Follicular / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology; D009364:Neoplasm Recurrence, Local; D012074:Remission Induction; D016879:Salvage Therapy; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide; C011272:perfosfamide