Myeloablative therapy with autologous bone marrow transplantation as consolidation therapy for follicular lymphoma

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Abstract
Since June 1985, 121 patients with follicular lymphoma aged 24–61 years (median 43) have received myeloablative therapy (cyclophosphamide: 60 mg/kg × 2, + total body irradiation: 200 cGy × 6) with autologous bone marrow transplantation (CY + TBI + ABMT) as consolidation of 2nd or subsequent remission. The marrow mononuclear cell fraction was treated in vitro with anti-CD20 alone and baby rabbit complement at St. Bartholomew's Hospital (SBH) and with the addition of anti-B5 and anti-CD10 at the Dana Farber Cancer Institute (DFCI) prior to reinfusion. There were 4 treatment related deaths, (nonengraftment 1, haemorrhage 1, systemic fungal infection 1, veno-occlusive disease 1). The median time for neutrophil recovery (>0.5 × 109/1) was 26 days (range 10 to 59 days), and for platelets (>20 × 10 9 /1) 30 days (range 12 to 73 days). One patient did not engraft and 7 have had delayed recovery of red cells and platelets (>3 months). Two other patients have subsequently developed acute myelogenous leukaemia and 5, evidence of my-elodysplasia. Seventy-one patients continue in unmaintained remission between 3 months and 7 years, with a median follow up of 2.5 years. Forty-three have developed recurrent lymphoma; 98 remain alive. Freedom from progression was the same, irrespective of whether patients received CY +TBI+ABMT whilst in a complete or partial remission and did not depend on the specific remission in which treatment was given (2nd: 90 patients vs. >2nd: 31 patients). In comparison with an age-matched, remission-matched historical control group (treated at SBH prior to 1985), the freedom from progression curve for patients receiving CY+TBI + ABMT in 2nd remission is significantly better than that of patients receiving conventional therapy (p = 0.001). The survival curves have not diverged significantly. These preliminary results are encouraging - it remains to be established whether further modifications to the treatment will improve the results.