autologous blood and marrow transplantation - Blog Science ...

146 Chapter 4: Lymphoma
after autoSCT have been examined in five series (D. Milligan for the European
Group for Blood and Marrow Transplantation [EBMT], personal communication).
15-17
' 21
Of note, two of these studies included non-Hodgkin's lymphoma
patients, 1721
and the variables examined were not the same in each series. Age
>35^10 years was a risk factor in the EBMT and Minnesota analyses (D. Milligan,
personal communication). 21
Splenectomy 15
and female sex (D. Milligan , personal
communication) were also associated with a higher risk in single series. The risk
was higher with the use of stem cells collected from the blood, rather than bone
marrow, in three of these studies. Specifically, the relative risk was 5.8 (P=Q.0\) in
the Minnesota study, 21
3.73 (P=0.077) in the French registry study, 15
and 3.57
(P=0.07) in the City of Hope study. 17
The reason for this observation is currently not
known, although patient selection may play a role. More information will be
forthcoming from an Autologous Bone Marrow Transplant Registry-National
Cancer Institute (ABMTR/NIH)study that evaluates post-autoSCT secondary
MDS/AML in more than 2500 patients with either non-Hodgkin's lymphoma or
Hodgkin's disease (C. Metayer for the NIH and ABMTR, personal communication).
Many types of solid tumors, as well as non-Hodgkin's lymphoma, have also been
reported after autoSCT. The types of tumors we and others have observed overlap
with those seen after conventional therapy 22-24
and include soft tissue sarcomas as
well as breast, lung, gastrointestinal, and other malignancies. In contrast to
MDS/AML, the French matched-comparison analysis showed that solid tumors
were more common after autoSCT than after conventional therapy. 15
Although
radiotherapy is a known risk factor for solid tumors after conventional therapy, 22-24
risk factors for this complication after autoSCT have not yet been identified. 15
In conclusion, late NRM has emerged as a worrisome cause of treatment failure
after autoSCT. The risk of fatal pulmonary fibrosis can likely be minimized by
using lower BCNU doses in the conditioning regimen and by prompt initiation of
steroids if symptoms develop. The risk of MDS/AML after autoSCT appears
similar to that seen after conventional therapy, and the available clinical data
suggest that marrow damage from prior cytotoxic therapy is likely the main factor
for the development of this complication, although a role for other factors cannot
be completely excluded. Further investigation of a possible increased risk of
MDS/AML with the use of blood stem cell transplants is needed. Finally, the risk .
of secondary solid tumors appears to be higher after autoSCT compared with
conventional therapy in Hodgkin's disease, and new strategies are required to
minimize this problem.
REFERENCES
1. Reece DE, Connors JM, Spinelli JJ, Barnett MJ, Fairey RN, Klingemann HG, Nantel SH,
O'Reilly S, Shepherd JD, Sutherland HJ, et al.: Intensive therapy with cyclophosphamide,