Myeloablative therapy with autologous bone marrow transplantation as consolidation of remission in patients with follicular lymphoma

Summary

A study has been in progress since June 1985 to evaluate the use of myeloablative therapy (cyclophosphamide [60 mg/kg × 21 and total body irradiation [200 cGy × 6]) followed by reinfusion of autologous bone marrow in patients in second or subsequent remission of B-cell non-Hodgkin’s lymphoma. The marrow mononuclear cell fraction is being treated in vitro with three cycles of the monoclonal antibody anti-CD20 (anti-B1, Coulter Immunology) and baby rabbit complement (Pel-Freez).

Thirty-eight patients with follicular lymphoma (age range 29–61 years, median 43) have been treated to date. At the time of treatment, 28 patients were in second remission, 7 were in third, and 3 were in more than third remission. Twenty-three patients were in complete remission, 15 had residual disease (7 had lymph nodes < 2 cm diameter, 4 had < 10% bone marrow infiltration, 1 had involvement of lymph nodes and bone marrow, and 3 had involvement at other sites). Of the 38 study patients, 32 are alive; 6 have died, 4 in remission. Two of the deaths were treatment related: 1 resulted from cerebral haemorrhage at 29 days; 1 resulted from systemic fungal infection at three months). One patient died from secondary acute myelogenous leukaemia at four years, and another from an unrelated cause. Two patients died following relapse. The median time to engraftment was 28 days (range 15–45 days) for neutrophils > 0.5 × 10⁹/L and 28 days (range 15–46 days) for platelets > 20 × 10⁹/L.

Twenty-six patients continue in remission between one month and five years (median follow-up 22 months); 8 have relapsed, 2 with transformation to high-grade histology. In the context of the natural history of follicular lymphoma these results are preliminary but encouraging. It remains to be established whether such intensive therapy is curative.