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

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.