Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission

A pilot study

Arnold S. Freedman, Tak Takvorian, Donna Neuberg, Peter Mauch, Susan N. Rabinowe, Kenneth C. Anderson, Robert J. Soiffer, Neil Spector, Michael Grossbard, Michael Robertson, Kelly Blake, Felice Coral, George P. Canellos, Jerome Ritz, Lee M. Nadler

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Abstract

Purpose: Using high-dose therapy and outologous bone marrow transplantation (ABMT) to overcome cellular resistance and eradicate minimal disease, we initiated a pilot study during first remission in patients with non-Hodgkin's lymphoma (NHL) to examine whether the long-term disease-free survival (DPS) rate can be improved for patients with poor-prognosis intermediate/ high-grade NHL. Patients and Methods: Twenty-six patients with advanced-stage diffuse intermediate/high-grade B-cell NHL (including 16 patients with diffuse small cleaved-cell [DSC]) were selected at presentation by histologic and clinical characteristics to have less than a 25% probability of long-term DFS with conventional treatment. After induction chemotherapy, 16 patients were in complete remission (CR) and 10 were in a minimal disease state. Patients were then treated with high-dose cyclophosphamide, total-body irradiation (TBI), and anti-B-cell monoclonal antibody-purged ABMT. Results: Following ABMT, no acute in-hospital treatment deaths occurred, and engraftment of granulocytes and platelets was significantly faster than for patients undergoing ABMT who were in second or subsequent remission. Of 26 patients, 21 remain in CR maintained without continued therapy, three relapsed in sites of prior nodal disease (4.8, 5.4, and 28 months post-ABMT), and two died in remission. The DPS rate is estimated to be 85% at 28 months and thereafter. The median followup period for the 21 patients who are alive and disease-free is 32 months. Conclusion: This pilot study suggests that consolidation of first remission with ABMT may improve the longterm DFS rate for diffuse intermediate/high-grade NHL patients at high risk for relapse.

Original languageEnglish (US)
Pages (from-to)931-936
Number of pages6
JournalJournal of Clinical Oncology
Volume11
Issue number5
StatePublished - 1993
Externally publishedYes

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Autologous Transplantation
B-Cell Lymphoma
Bone Marrow Transplantation
Non-Hodgkin's Lymphoma
Induction Chemotherapy
Whole-Body Irradiation
Therapeutics
Granulocytes
Cyclophosphamide
Disease-Free Survival
B-Lymphocytes
Blood Platelets
Survival Rate
Monoclonal Antibodies
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Freedman, A. S., Takvorian, T., Neuberg, D., Mauch, P., Rabinowe, S. N., Anderson, K. C., ... Nadler, L. M. (1993). Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission: A pilot study. Journal of Clinical Oncology, 11(5), 931-936.

Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission : A pilot study. / Freedman, Arnold S.; Takvorian, Tak; Neuberg, Donna; Mauch, Peter; Rabinowe, Susan N.; Anderson, Kenneth C.; Soiffer, Robert J.; Spector, Neil; Grossbard, Michael; Robertson, Michael; Blake, Kelly; Coral, Felice; Canellos, George P.; Ritz, Jerome; Nadler, Lee M.

In: Journal of Clinical Oncology, Vol. 11, No. 5, 1993, p. 931-936.

Research output: Contribution to journalArticle

Freedman, AS, Takvorian, T, Neuberg, D, Mauch, P, Rabinowe, SN, Anderson, KC, Soiffer, RJ, Spector, N, Grossbard, M, Robertson, M, Blake, K, Coral, F, Canellos, GP, Ritz, J & Nadler, LM 1993, 'Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission: A pilot study', Journal of Clinical Oncology, vol. 11, no. 5, pp. 931-936.
Freedman, Arnold S. ; Takvorian, Tak ; Neuberg, Donna ; Mauch, Peter ; Rabinowe, Susan N. ; Anderson, Kenneth C. ; Soiffer, Robert J. ; Spector, Neil ; Grossbard, Michael ; Robertson, Michael ; Blake, Kelly ; Coral, Felice ; Canellos, George P. ; Ritz, Jerome ; Nadler, Lee M. / Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission : A pilot study. In: Journal of Clinical Oncology. 1993 ; Vol. 11, No. 5. pp. 931-936.
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abstract = "Purpose: Using high-dose therapy and outologous bone marrow transplantation (ABMT) to overcome cellular resistance and eradicate minimal disease, we initiated a pilot study during first remission in patients with non-Hodgkin's lymphoma (NHL) to examine whether the long-term disease-free survival (DPS) rate can be improved for patients with poor-prognosis intermediate/ high-grade NHL. Patients and Methods: Twenty-six patients with advanced-stage diffuse intermediate/high-grade B-cell NHL (including 16 patients with diffuse small cleaved-cell [DSC]) were selected at presentation by histologic and clinical characteristics to have less than a 25{\%} probability of long-term DFS with conventional treatment. After induction chemotherapy, 16 patients were in complete remission (CR) and 10 were in a minimal disease state. Patients were then treated with high-dose cyclophosphamide, total-body irradiation (TBI), and anti-B-cell monoclonal antibody-purged ABMT. Results: Following ABMT, no acute in-hospital treatment deaths occurred, and engraftment of granulocytes and platelets was significantly faster than for patients undergoing ABMT who were in second or subsequent remission. Of 26 patients, 21 remain in CR maintained without continued therapy, three relapsed in sites of prior nodal disease (4.8, 5.4, and 28 months post-ABMT), and two died in remission. The DPS rate is estimated to be 85{\%} at 28 months and thereafter. The median followup period for the 21 patients who are alive and disease-free is 32 months. Conclusion: This pilot study suggests that consolidation of first remission with ABMT may improve the longterm DFS rate for diffuse intermediate/high-grade NHL patients at high risk for relapse.",
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T1 - Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission

T2 - A pilot study

AU - Freedman, Arnold S.

AU - Takvorian, Tak

AU - Neuberg, Donna

AU - Mauch, Peter

AU - Rabinowe, Susan N.

AU - Anderson, Kenneth C.

AU - Soiffer, Robert J.

AU - Spector, Neil

AU - Grossbard, Michael

AU - Robertson, Michael

AU - Blake, Kelly

AU - Coral, Felice

AU - Canellos, George P.

AU - Ritz, Jerome

AU - Nadler, Lee M.

PY - 1993

Y1 - 1993

N2 - Purpose: Using high-dose therapy and outologous bone marrow transplantation (ABMT) to overcome cellular resistance and eradicate minimal disease, we initiated a pilot study during first remission in patients with non-Hodgkin's lymphoma (NHL) to examine whether the long-term disease-free survival (DPS) rate can be improved for patients with poor-prognosis intermediate/ high-grade NHL. Patients and Methods: Twenty-six patients with advanced-stage diffuse intermediate/high-grade B-cell NHL (including 16 patients with diffuse small cleaved-cell [DSC]) were selected at presentation by histologic and clinical characteristics to have less than a 25% probability of long-term DFS with conventional treatment. After induction chemotherapy, 16 patients were in complete remission (CR) and 10 were in a minimal disease state. Patients were then treated with high-dose cyclophosphamide, total-body irradiation (TBI), and anti-B-cell monoclonal antibody-purged ABMT. Results: Following ABMT, no acute in-hospital treatment deaths occurred, and engraftment of granulocytes and platelets was significantly faster than for patients undergoing ABMT who were in second or subsequent remission. Of 26 patients, 21 remain in CR maintained without continued therapy, three relapsed in sites of prior nodal disease (4.8, 5.4, and 28 months post-ABMT), and two died in remission. The DPS rate is estimated to be 85% at 28 months and thereafter. The median followup period for the 21 patients who are alive and disease-free is 32 months. Conclusion: This pilot study suggests that consolidation of first remission with ABMT may improve the longterm DFS rate for diffuse intermediate/high-grade NHL patients at high risk for relapse.

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