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Autologous bone marrow transplantation in follicular non-Hodgkin's lymphoma
before and after histologic transformation
HC Schouten, PJ Bierman, WP Vaughan, A Kessinger, JM Vose, DD Weisenburger and JO Armitage
Department of Internal Medicine, University of Nebraska Medical Center,
Omaha 68105-1065.
Patients with disseminated follicular non-Hodgkin's lymphoma (NHL) are only
occasionally cured with standard chemotherapy regimens. Although most of
these tumors are initially responsive to chemotherapy, in 40% to 70% of
patients the lymphoma will eventually transform to an NHL of higher grade
malignancy and a poorer prognosis. We treated 18 patients having an
original diagnosis of follicular NHL with high-dose therapy and autologous
bone marrow transplantation. The lymphomas of 10 of the patients had
already undergone histologic transformation and eight still had a
follicular histologic pattern. The former group had been followed for a
longer time from the diagnosis of NHL and had been more extensively treated
with conventional chemotherapy regimens. All eight patients with follicular
NHL at the time of transplantation are alive for 246+ to 1,804+ days and
seven of the patients are in complete remission. In contrast, of the 10
patients in histologic transformation only 1 is alive and in CR. This
reflects the inability of these patients to tolerate the high-dose
chemotherapy and myelosuppression as well as resistance of their lymphoma
to this therapy. This difference in survival between the two groups was
highly significant (P = .002). We conclude that the outcome of patients
with follicular NHL transplanted early before histologic transformation is
better than for those who are transplanted later in the course of their
illness. Because of the relapsing behavior of follicular NHL, a longer
follow-up is necessary to prove any impact on the natural history of the
disease.
Volume 74,
Issue 7,
pp. 2579-2584,
11/15/1989
Copyright © 1989 by The American Society of Hematology
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