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Autologous bone marrow transplantation for high-grade lymphoid malignancy
using melphalan/irradiation conditioning without marrow purging or
cryopreservation. The Northern Regional Bone Marrow Transplant Group
PJ Carey, SJ Proctor, P Taylor and PJ Hamilton
University Department of Haematology, Royal Victoria Infirmary, Newcastle
upon Tyne, England.
We report the safety and efficacy of 34 consecutive autologous bone marrow
transplant (ABMT) procedures performed in adult patients with high-grade
lymphoid malignancy after remission induction therapy. Fifteen patients
with acute lymphoblastic leukemia (ALL) and six with high-grade
non-Hodgkin's lymphoma (NHL) received pretransplant conditioning with
intravenous (IV) melphalan and fractionated total body irradiation (TBI).
Thirteen other patients with NHL were conditioned with melphalan alone,
having previously received local involved field radiotherapy. Unmanipulated
noncryopreserved autologous marrow was reinfused within 48 hours of
harvesting. Engraftment occurred in all patients with medians of 10 days of
neutropenia (neutrophils less than 0.5 x 10(9)/L), 4-day platelet
transfusion requirement, 3 U packed RBC transfusion, and 18 days in
hospital posttransplant. There were no procedure-related deaths. Actuarial
disease-free survival in the 13 patients with ALL receiving autotransplant
early in first remission is 48% with a median follow-up of 3 years. Two
other ALL patients who had autotransplants after a period of maintenance
therapy also remain in complete remission (CR). These results compare
favorably with our 34% disease-free survival (DFS) in 15 allogeneic ALL
transplant patients and 21% DFS in 19 patients on standard maintenance
after a common induction schedule. No relapses have occurred in the 17 NHL
patients transplanted in remission (median follow-up 2 years), but the two
NHL patients who developed recurrent disease before ABMT died of
progressive disease after temporary responses. We conclude that this method
of ABMT results in rapid reengraftment with lack of toxicity and that the
conditioning treatment used shows good efficacy against disease. It is
applicable in high-grade lymphoid malignancy in first remission, and our
results call into question the need for marrow purging in ALL and NHL
patients transplanted in first remission.
Volume 77,
Issue 7,
pp. 1593-1598,
04/01/1991
Copyright © 1991 by The American Society of Hematology
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