Autologous bone marrow transplantation after histologic ...

13 downloads 0 Views 156KB Size Report
Autologous transplantation • Indolent lymphoma • Histologic transformation ..... Foucar K, Rydell R: Richter's syndrome in chronic lymphocytic leukemia. Cancer ...
Biology of Blood and Marrow Transplantation 5:262–268 (1999) © 1999 American Society for Blood and Marrow Transplantation

ASBMT #04

Autologous bone marrow transplantation after histologic transformation of indolent B cell malignancies Jonathan W. Friedberg,1,3,5 Donna Neuberg,2 John G. Gribben,1,3,5 Peter Mauch,4,6 Kenneth C. Anderson,1,3,5 Robert J. Soiffer,1,3,5 Tak Takvorian,1,3,5 David C. Fisher,1,3,5 Robert Schlossman,1,3,5 Haddie Jallow,1 Caroline Kuhlman,1 Jerome Ritz,1,3,5 Arnold S. Freedman1,3,5 Divisions of 1Adult Oncology and 2Biostatistics, Dana-Farber Cancer Institute; Departments of 3Medicine and 4Radiation Therapy, Brigham and Women’s Hospital; and Departments of 5Medicine and 6Radiation Oncology, Harvard Medical School, Boston, Massachusetts Offprint requests: Arnold S. Freedman, MD, Division of Adult Oncology, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115 (Received 26 January 1999; accepted 18 March 1999)

ABSTRACT The role of high-dose therapy and autologous stem cell transplantation in diffuse large B cell lymphoma (DLBCL) after transformation is controversial. We have retrospectively analyzed patients with chemosensitive disease and a history of follicular lymphoma or chronic lymphocytic leukemia/small lymphocytic lymphoma who underwent highdose chemoradiotherapy and bone marrow transplantation (BMT) with anti–B cell monoclonal antibody–purged autologous marrow for DLBCL. Between December 1982 and August 1997, 27 patients underwent autologous BMT using a uniform ablative regimen with cyclophosphamide, total-body irradiation, and bone marrow purging. All patients received multiple chemotherapy regimens before autologous BMT. At bone marrow (BM) harvest, only 44% of patients were in complete remission, and overt BM infiltration was present in 37%. After cyclophosphamide and total-body irradiation, no treatment-related deaths were seen. Eleven of the 27 patients relapsed, and four patients developed myelodysplasia/acute myelogenous leukemia. In seven patients in whom pathologic studies were available after relapse, the histology remained DLBCL. Twelve patients remained alive and in complete remission with a median follow-up of 36 months (range 10–132). The disease-free survival and overall survival are estimated to be 46% (90% confidence interval 28–64) and 58% (40–76) at 5 years, respectively. Patients whose disease underwent histologic transformation within 18 months of their initial diagnosis of indolent lymphoma had significantly better overall survival. Selected patients with histologic transformation, particularly those whose transformation occurs early in the course of their disease and who remain chemosensitive, may experience prolonged survival after autoBMT.

KEY WORDS: Autologous transplantation



Indolent lymphoma

INTRODUCTION Patients with advanced-stage, low-grade non-Hodgkin’s lymphoma (NHL) have a variable but usually long natural history, with a median survival of 6–10 years after diagnosis [1]. A major cause of morbidity and mortality in this group of patients is transformation of the low-grade lymphoma to one

Supported by National Institutes of Health grant CA66996.

262



Histologic transformation

with a diffuse aggressive histology, with median survival after histologic conversion in most series of