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

Summary:Studies evaluating the effects of previous chemotherapy on stem-cell yield and hematological recovery after autologous peripheral-blood progenitor-cell transplantation (PBPCT) have shown conflicting results. We have retrospectively analyzed 103 consecutive lymphoma patients treated with the BEAM regimen and autologous PBPCT. The impact of the different chemotherapeutic drugs (cumulative doses) on stem-cell yield and transplant-related toxicity was investigated. Highly significant differences in platelet recovery (420 Â 10 9 /l) were observed between patients receiving less or more than 750 mg/m 2 of etoposide before transplant (15 vs 29 days, P ¼ 0.001), and between patients receiving less or more than 1.2 Â 10 6 /kg CD34 þ cells (27 vs 14 days, Po0.001). Differences in neutrophil engraftment between groups were not clinically significant. Pre-transplant cumulative doses of etoposide 4750 mg/m 2 were associated with low CD34 þ cell collections on multivariate analysis. The actuarial incidence of transplant-related mortality (TRM) was 14% at 5 years. Pre-transplant cumulative doses of etoposide 4350 mg/m 2 and previous administration of procarbazine were found to be independent prognostic factors for TRM.

Section: Beam; Cd34 þ Cellsmentioning

confidence: 99%

Effect of cumulative etoposide doses on the outcome of autologous peripheral-blood progenitor-cell transplantation for lymphoma

Martı́n

Pérez‐Simón

Caballero

et al. 2004

“…2 The role of such treatment intensification in the histologically indolent lymphomas is less clear and results from randomised controlled trials have not yet been reported. However, several non-randomised studies have suggested prolonged disease-free survival in patients with histologically indolent NHL who have received high-dose therapy with stem cell support, [3][4][5][6] and such treatment intensification is increasingly used in younger patients.…”

mentioning

confidence: 99%

Progenitor cell yields are frequently poor in patients with histologically indolent lymphomas especially when mobilized within 6 months of previous chemotherapy

et al. 1998

Summary:High-dose therapy with peripheral blood stem cell (PBSC) support is a frequently used treatment option in younger patients with poor prognosis histologically indolent (low-grade) non-Hodgkin's lymphoma (NHL), usually at the time of second or subsequent response to conventional-dose therapy. We have undertaken PBSC collection in 57 patients with histologically indolent NHL mobilized with either cyclophosphamide 1.5 g/m 2 or the ESHAP regimen, followed by daily G-CSF. Progenitor cell yields were determined by quantification of CD34 + cells and GM-CFC. Twelve patients (21%) failed to achieve the minimum progenitor cell requirements of 1 × 10 6 /kg CD34 + cells or 1 × 10 5 /kg GM-CFC in their pooled harvests and 40 patients (70%) failed to achieve the optimal harvest thresholds of 3.5 × 10 6 /kg CD34 + cells or 3.5 × 10 5 /kg GM-CFC. This high failure rate is significantly higher than that in patients with histologically aggressive NHL or Hodgkin's disease. A multivariate analysis was performed to identify factors contributing to the low stem cell yields in this group. This identified the time interval from the last chemotherapy to the priming chemotherapy as the most important predictive factor. With respect to CD34 and GM-CFC numbers, on the single harvest on the day the white cell count first exceeded 5 × 10 9 /l the P values were 0.0078 and 0.0065, respectively, and for the progenitor cell values on the pooled harvests the P values were 0.004 for CD34 + cells and 0.015 for GM-CFC. Progenitor cell yields may therefore be improved in patients with low grade lymphoma by harvesting at diagnosis if no marrow disease is present, or by delaying mobilization for 6 months post-chemotherapy in patients in first or subsequent remission.

“…[1][2][3][4] However, the value of such therapy in patients with low-grade lymphoma is less well established. 5 Issues such as the optimal timing of therapy, [5][6][7] the value of purging, [7][8][9] and the relative merit of autologous stem cells vs allogeneic stem cells 10 remain unresolved. Since some patients with low-grade NHL may experience prolonged survival, even with limited initial therapy such as 'watchful waiting', it is difficult to establish that high-dose therapy has an impact on the survival of patients with low-grade NHL.…”

mentioning

confidence: 99%

High-dose therapy with autologous or allogeneic transplantation as salvage therapy for small cleaved cell lymphoma of follicular center cell origin

Stein

Greer

Goodman

et al. 1999

Summary:Between 1985 and 1996, 51 patients with relapsed or refractory small cleaved cell lymphoma (SCCL) received high-dose chemotherapy ؎ TBI in conjunction with autologous (ABMT) (36 patients) or allogeneic transplantation (15 patients). Patients were eligible for ABMT if the bone marrow biopsy done prior to the planned transplant did not reveal microscopic involvement with SCCL. Patients receiving ABMT had a median age of 48 years, had received a median of 2.5 chemotherapy regimens prior to transplantation, and were transplanted a median of 35.5 months from diagnosis. Among patients receiving ABMT, 5 year actuarial survival was 56 ؎ 11%. Median survival was 126؉ months, and median survival from diagnosis was 191 months. Univariate and multivariate analysis identified sensitive disease as the best predictor of a favorable response. Five-year actuarial survival was 66 ؎ 12% for patients with sensitive disease at the time of transplant as compared to 29 ؎ 17% for patients with resistant disease, P = 0.015. Median survival in patients with sensitive disease at the time of ABMT was 126؉ months. By univariate analysis, survival was significantly better for patients receiving ABMT as compared to patients receiving allogeneic transplants. Median survival following allogeneic transplantation was 5 months; 5 year actuarial survival was 15 ؎ 13%. In a multivariate analysis, which considered autologous vs allogeneic transplantation, sensitive vs resistant disease, Ͻ3 vs у3 prior treatments, and prior bone marrow involvement, allogeneic transplantation was significantly associated with poor survival. Treatment-related mortality occurred in eight of 15 patients receiving allogeneic transplantation and limited the effectiveness of this therapy. High-dose therapy in conjunction with ABMT is effective therapy for patients with SCCL whose disease is sensitive to chemotherapy and whose marrows are microscopically free of disease. Because of possible selection bias, it has not been proven that this approach increases survival in these patients. Treatment-related