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Blood, Vol. 94 No. 10 (November 15), 1999:
pp. 3325-3333
Long-Term Follow-Up of Autologous Bone Marrow Transplantation in
Patients With Relapsed Follicular Lymphoma
Arnold S. Freedman,
Donna Neuberg,
Peter Mauch,
Robert J. Soiffer,
Kenneth C. Anderson,
David C. Fisher,
Robert Schlossman,
Edwin P. Alyea,
Tak Takvorian,
Haddy Jallow,
Caroline Kuhlman,
Jerome Ritz,
Lee M. Nadler, and
John G. Gribben
From the Department of Adult Oncology and Biostatistics, Dana-Farber
Cancer Institute, the Department of Radiation Therapy, Brigham and
Women's Hospital, and the Departments of Medicine and Radiation
Oncology, Harvard Medical School, Boston, MA.
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.
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