Long-Term Survival after Autologous Bone Marrow Transplantation for Follicular Lymphoma in First Remission

摘要

The role of autologous stem cell transplantation (ASCT) in the treatment of follicular lymphoma is still being defined in the era of antibody therapy. Here we report the long-term 12 year clinical outcomes of patients treated with autologous bone marrow transplantation (ABMT) for follicular NHL in first remission. Between 1988 and 1993, advanced stage follicular NHL patients in need of initial therapy were enrolled on two consecutive prospective treatment trials of either standard dose CHOP induction (83 patients) or high dose CHOP plus G-CSF (20 patients). Patients who achieved an adequate remission with induction therapy underwent conditioning with cyclophosphamide and total body irradiation followed by ABMT in first remission using bone marrow purged in vitro with anti-B cell monoclonal antibodies and rabbit complement (96 patients). At 12 year follow-up, 61% of the patients are alive and 43% remain in continuing complete remission. The only predictors of decreased progression-free survival proved to be histologic bone marrow involvement at time of harvest (HR 2.27 (95% CI 1.3-3.9), p < 0.004) and PCR detectable disease in the bone marrow product after purging (HR 4.18 (95% CI 1.99-8.8), p = 0.0002). No significant predictors of overall survival were identified. These results at 12 year follow-up suggest that a subset of follicular lymphoma patients can experience prolonged survival with ABMT in first remission.