High-dose therapy and autologous bone marrow transplantation in patients with follicular lymphoma during first remission.

Abstract

We report the results of a study in previously untreated advanced stage patients with follicular lymphoma (FL) who underwent uniform induction chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) followed by myeloablative therapy and anti-B-cell monoclonal antibody purged autologous bone marrow transplantation (ABMT). Eighty-three patients with previously untreated, low-grade FL were enrolled. After CHOP induction, only 36% achieved complete remission (CR) and 77 patients underwent ABMT. Before BM harvest, 70 patients had a known t(14;18), as determined by polymerase chain reaction (PCR), and all remained PCR positive in the BM at harvest. After ABMT, the disease-free survival (DFS) and overall survival are estimated to be 63% and 89% at 3 years, respectively, with a median follow-up of 45 months. Patients whose BM was PCR negative after purging experienced significantly longer freedom from recurrence (FFR) than those whose BM remained PCR positive (P = .0006). Continued PCR negativity in follow-up BM samples was also strongly predictive of continued CR. This study suggests that a subset of patients with advanced FL may experience prolonged clinical and molecular remissions following high-dose ablative therapy, although longer follow-up will be necessary to determine potential impact on overall survival.

• Authors: A S Freedman, J G Gribben, D Neuberg, P Mauch, R J Soiffer, K C Anderson, L Pandite, M J Robertson, M Kroon, J Ritz, L M Nadler
• Journal: Blood (Blood) Vol. 88 Issue 7 Pg. 2780-6 (Oct 01 1996) ISSN: 0006-4971 [Print] United States
• PMID: 8839876 (Publication Type: Clinical Trial, Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Biomarkers, Tumor
• Immunoglobulin Heavy Chains
• Neoplasm Proteins
• Proto-Oncogene Proteins c-bcl-2
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Biomarkers, Tumor (genetics)
• Bone Marrow Transplantation
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Female
• Follow-Up Studies
• Humans
• Immunoglobulin Heavy Chains (genetics)
• Life Tables
• Lymphoma, Follicular (drug therapy, mortality, radiotherapy, therapy)
• Male
• Middle Aged
• Neoplasm Proteins (genetics)
• Neoplasm Recurrence, Local
• Polymerase Chain Reaction
• Prednisone (administration & dosage)
• Proportional Hazards Models
• Proto-Oncogene Proteins c-bcl-2 (genetics)
• Remission Induction
• Survival Analysis
• Transplantation Conditioning
• Transplantation, Autologous
• Treatment Outcome
• Vincristine (administration & dosage)
• Whole-Body Irradiation