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Blood, 15 January 2001, Vol. 97, No. 2, pp. 404-409
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
High-dose therapy and autologous bone marrow transplantation for
follicular lymphoma in first complete or partial remission: results of
a phase II clinical trial
Sandra J. Horning,
Robert
S. Negrin,
Richard T. Hoppe,
Saul A. Rosenberg,
Nelson J. Chao,
Gwynn D. Long,
B. William Brown, and
Karl G. Blume
From the Department of Medicine, Divisions of Bone
Marrow Transplantation and Medical Oncology, Department of Radiation
Oncology, and Department of Health Research and Policy, Division of
Biostatistics, Stanford University Medical Center, Stanford, CA.
Advanced stage follicular small cleaved and mixed cell lymphoma is
characterized by relapse from remission and survival ranging from 6 to
12 years. Because young patients have the greatest compromise in
longevity, the efficacy and toxicity of high-dose radiochemotherapy and bone marrow transplantation after conventional chemotherapy was
evaluated in a prospective phase II clinical trial. Thirty-seven patients in a minimal disease state after conventional chemotherapy received fractionated total body irradiation and high-dose etoposide and cyclophosphamide, followed by purged autologous bone marrow. A
reference sample of 188 patients of similar age, stage, and histology
managed at this institution before 1988 was identified for comparison
of patient characteristics and outcomes. Compared with reference
patients, transplant recipients had a higher tumor burden at diagnosis.
With a median follow-up of 6.5 years, the estimated 10-year survival
after transplantation was 86%. There was a single lymphoma death
yielding a 10-year disease-specific survival of 97%. There were 2 early transplant-related deaths and 2 late acute leukemia deaths. Ten
patients relapsed, one with microscopic disease only. High tumor burden
at diagnosis and incomplete response to chemotherapy adversely
influenced survival in the reference but not in the transplanted
patients. The estimated risk of death of 14% and relapse of 30% at 10 years in our transplanted follicular lymphoma patients, the majority of
whom had high tumor burdens, compares favorably with our observations
in appropriately matched reference patients.
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