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Blood, Vol. 96 No. 3 (August 1), 2000:
pp. 864-869
Successful in vivo purging of CD34-containing peripheral blood
harvests in mantle cell and indolent lymphoma: evidence for a role
of both chemotherapy and rituximab infusion
Michele Magni,
Massimo Di Nicola,
Liliana Devizzi,
Paola Matteucci,
Fabrizio Lombardi,
Lorenza Gandola,
Fernando Ravagnani,
Roberto Giardini,
Giuseppe Dastoli,
Corrado Tarella,
Alessandro Pileri,
Gianni Bonadonna, and
Alessandro M. Gianni
From the Department of Oncology, University of Milan, Milan, Italy;
the Divisions of Medical Oncology C, Radiotherapy, and Pathology,
National Cancer Institute, Milan, Italy; the Department of Hematology,
University of Turin, Turin, Italy; and Roche SpA, Milan, Italy.
Elimination of tumor cells ("purging") from hematopoietic stem
cell products is a major goal of bone marrow-supported high-dose cancer chemotherapy. We developed an in vivo purging method capable of
providing tumor-free stem cell products from most patients with mantle
cell or follicular lymphoma and bone marrow involvement. In a
prospective study, 15 patients with CD20+ mantle cell or
follicular lymphoma, bone marrow involvement, and polymerase chain
reaction (PCR)-detectable molecular rearrangement received 2 cycles of
intensive chemotherapy, each of which was followed by infusion of a
growth factor and 2 doses of the anti-CD20 monoclonal antibody
rituximab. The role of rituximab was established by comparison with 10 control patients prospectively treated with an identical chemotherapy
regimen but no rituximab. The CD34+ cells harvested from
the patients who received both chemotherapy and rituximab were
PCR-negative in 93% of cases (versus 40% of controls;
P = .007). Aside from providing PCR-negative harvests, the
chemoimmunotherapy treatment produced complete clinical and molecular
remission in all 14 evaluable patients, including all 6 with mantle
cell lymphoma (versus 70% of controls). In vivo purging of
hematopoietic progenitor cells can be successfully accomplished in most
patients with CD20+ lymphoma, including mantle cell
lymphoma. The results depended on the activity of both chemotherapy and
rituximab infusion and provide the proof of principle that in vivo
purging is feasible and possibly superior to currently available ex
vivo techniques. The high short-term complete-response rate observed
suggests the presence of a more-than-additive antilymphoma effect of
the chemoimmunotherapy combination used.
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