Survival Benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Concerns About Omissions in the Data Presented

2001 ◽  
Vol 19 (6) ◽  
pp. 1884-1884
Author(s):  
R.D. Kennedy ◽  
R.G. Cuthbert ◽  
P.J. Kettle ◽  
T.C.M. Morris
Keyword(s):  
Survival Benefit ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Poor Risk ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

scholarly journals Significance of detection of occult non-Hodgkin's lymphoma in histologically uninvolved bone marrow by a culture technique

Blood ◽  
1992 ◽  
Vol 79 (4) ◽  
pp. 1074-1080 ◽  
Author(s):  
JG Sharp ◽  
SS Joshi ◽  
JO Armitage ◽  
P Bierman ◽  
PF Coccia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Hodgkin’S Lymphoma ◽  
Culture Technique ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Lymphoma Cells ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Abstract Prolonged disease-free survival of patients with recurrent or resistant non-Hodgkin's lymphoma (NHL) has been achieved with high-dose therapy followed by autologous bone marrow transplantation (ABMT). A concern with the use of ABMT is that the marrow that is reinfused may contain undetected NHL cells with the potential to reestablish metastatic disease in the recipient. Using a culture technique that is sensitive for detecting occult lymphoma cells in BM, we analyzed histologically normal marrow harvests from 59 consecutive patients with intermediate- or high-grade NHL who were candidates for high-dose therapy and ABMT. The culture results indicated that 22 of the patients had occult lymphoma in their marrow. Forty-three patients underwent high-dose therapy followed by ABMT. Twenty-four achieved a complete clinical remission. Those with occult lymphoma in their harvests (11 patients) continued to relapse for up to 3 years, whereas no relapses were observed beyond 8 months in 13 patients receiving marrow that did not contain detectable lymphoma cells using the culture technique. The relapses in the patients who achieved a complete remission occurred at sites of prior bulky disease rather than at new sites, suggesting that the ability to detect occult lymphoma cells in marrow is a marker of biologic aggressiveness and/or resistance to therapy, or that the reinfused cells could only grow in previously involved sites. The detection of lymphoma cells in marrow used for ABMT is an important adverse prognostic factor, and appears to be independent of other clinical predictors of outcome such as sensitivity or resistance of disease to prior chemotherapy.

High-Dose Therapy with Autologous Transplantation for Aggressive Non-Hodgkin's Lymphoma: The Bologna Experience

2004 ◽  
Vol 45 (2) ◽  
pp. 321-326 ◽  
Author(s):  
Pier Luigi Zinzani ◽  
Monica Tani ◽  
Annalisa Gabriele ◽  
Filippo Gherlinzoni ◽  
Antonello de Vivo ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Autologous Transplantation ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

scholarly journals Significance of detection of occult non-Hodgkin's lymphoma in histologically uninvolved bone marrow by a culture technique

Blood ◽  
1992 ◽  
Vol 79 (4) ◽  
pp. 1074-1080 ◽  
Author(s):  
JG Sharp ◽  
SS Joshi ◽  
JO Armitage ◽  
P Bierman ◽  
PF Coccia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Hodgkin’S Lymphoma ◽  
Culture Technique ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Lymphoma Cells ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Prolonged disease-free survival of patients with recurrent or resistant non-Hodgkin's lymphoma (NHL) has been achieved with high-dose therapy followed by autologous bone marrow transplantation (ABMT). A concern with the use of ABMT is that the marrow that is reinfused may contain undetected NHL cells with the potential to reestablish metastatic disease in the recipient. Using a culture technique that is sensitive for detecting occult lymphoma cells in BM, we analyzed histologically normal marrow harvests from 59 consecutive patients with intermediate- or high-grade NHL who were candidates for high-dose therapy and ABMT. The culture results indicated that 22 of the patients had occult lymphoma in their marrow. Forty-three patients underwent high-dose therapy followed by ABMT. Twenty-four achieved a complete clinical remission. Those with occult lymphoma in their harvests (11 patients) continued to relapse for up to 3 years, whereas no relapses were observed beyond 8 months in 13 patients receiving marrow that did not contain detectable lymphoma cells using the culture technique. The relapses in the patients who achieved a complete remission occurred at sites of prior bulky disease rather than at new sites, suggesting that the ability to detect occult lymphoma cells in marrow is a marker of biologic aggressiveness and/or resistance to therapy, or that the reinfused cells could only grow in previously involved sites. The detection of lymphoma cells in marrow used for ABMT is an important adverse prognostic factor, and appears to be independent of other clinical predictors of outcome such as sensitivity or resistance of disease to prior chemotherapy.

High-dose therapy followed by bone marrow transplantation for relapsed follicular non-hodgkin's lymphoma

1996 ◽  
Vol 73 (6) ◽  
pp. 273-277 ◽  
Author(s):  
H. C. Schouten ◽  
J. J. M. Raemaekers ◽  
J. C. Kluin-Nelemans ◽  
H. van Kamp ◽  
W. A. M. Mellink ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Randomized Study to Evaluate the Use of High-Dose Therapy as Part of Primary Treatment for “Aggressive” Lymphoma

2002 ◽  
Vol 20 (22) ◽  
pp. 4413-4419 ◽  
Author(s):  
Ulrich Kaiser ◽  
Irmgard Uebelacker ◽  
Ulrich Abel ◽  
Josef Birkmann ◽  
Lorenz Trumper ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Primary Treatment ◽  
Hodgkin's Lymphoma ◽  
Phase Iii ◽  
Serum Lactate Dehydrogenase ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

PURPOSE: This trial of the German High-Grade Non-Hodgkin’s Lymphoma Study Group compares the use of high-dose therapy (HDT) as part of primary treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide followed by involved-field (IF) radiotherapy in a randomized, multicenter, phase III study. PATIENTS AND METHODS: Three hundred twelve patients with “aggressive” non-Hodgkin’s lymphoma aged ≤ 60 years with elevated serum lactate dehydrogenase levels were included from 1990 to 1997. Patients with at least a minor response after two cycles of CHOEP (CHOP + etoposide 3 × 100 mg/m2) were to receive three further cycles of CHOEP followed by IF radiotherapy (arm A) or one further cycle of CHOEP followed by autologous stem-cell transplantation and IF radiotherapy (arm B). RESULTS: Among 158 patients randomized to arm B, 103 (65%) received HDT. The complete remission rate at the end of treatment was 62.9% in arm A and 69.9% in arm B. With a median observation time of 45.5 months, overall survival for all 312 patients was 63% after 3 years (63% for arm A, 62% for arm B; P = .68). Event-free survival was 49% for arm A versus 59% for arm B (P = .22). Relapse in arm B was associated with a significantly worse survival rate than relapse in arm A (P < .05). Relapse after HDT occurred early (median interval, 3 months). Six patients developed secondary neoplasia, three in arm A and three in arm B. CONCLUSION: Results of the randomized trial comparing CHOP-like chemotherapy with early HDT do not support the use of HDT with carmustine, etoposide, cytarabine, and melphalan following shortened standard chemotherapy.

Outcome of high-dose therapy and autologous transplantation in non-Hodgkin's lymphoma based on the presence of tumor in the marrow or infused hematopoietic harvest.

1996 ◽  
Vol 14 (1) ◽  
pp. 214-219 ◽  
Author(s):  
J G Sharp ◽  
A Kessinger ◽  
S Mann ◽  
D A Crouse ◽  
J O Armitage ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Hodgkin’S Lymphoma ◽  
Autologous Bone Marrow Transplantation ◽  
Autologous Transplantation ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Dose Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

PURPOSE To evaluate the outcomes in 65 consecutive patients with non-Hodgkin's lymphoma (NHL) undergoing high-dose therapy (HDT) and autologous transplantation based on initial marrow involvement and the presence or absence of minimal disease in the hematopoietic harvests. PATIENTS AND METHODS Patients with any history of histologic evidence of marrow tumor underwent autologous peripheral-blood stem-cell transplantation (PSCT), whereas others underwent autologous bone marrow transplantation (ABMT). Patients who underwent ABMT were further segregated retrospectively into two groups depending on whether there was evidence by cell culture and/or Southern analysis of minimal tumor in the marrow harvest. RESULTS Comparable proportions (58% to 60%) of patients in each of the two groups (PSCT and ABMT) achieved a complete clinical remission (CR) at 100 days. For patients who achieve a CR, the actuarial relapse-free survival rate at 5 years for PSCT patients who received a tumor-negative apheresis harvest was 64%, compared with 57% for patients who received a tumor-negative bone marrow harvest and 17% for patients who received a histologically negative but minimally contaminated bone marrow harvest. Lymphoma grade and phenotype were not significant predictors of outcome. CONCLUSION The observation that survival was significantly better in the groups of patients who received tumor-negative harvests and worse for patients who received minimally contaminated harvests suggests that tumor cells, even at minimal levels, reinfused in the transplanted harvest are responsible for progression in a proportion of patients who achieve a CR following HDT, although other biologic characteristics of the tumor could also be important. A relatively good outcome can be achieved with HDT and PSCT, even in patients with a significant marrow tumor burden.

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