autologous blood and marrow transplantation - Blog Science ...

Sweetenham et al.
vs. autologous peripheral blood progenitor cells vs. allogeneic bone marrow) and
purging/positive stem cell selection had no effect on the frequency of local relapse.
Median survival after relapse was 15 months, and was inversely correlated with
histologic grade (/MXOOOOOl). No difference in survival was seen according to
local vs. distant relapse. These results confirm the poor outlook for all patients
relapsing after SCT for NHL, irrespective of the pattern of relapse. Patterns of
relapse after SCT are related to clinical features of the disease before autoSCT
rather than to treatment variables. New strategies are urgently required to improve
the poor outlook for this group of patients.
INTRODUCTION
High-dose therapy and autoSCT is a curative treatment modality in some
patients with relapsed, aggressive NHL. 1
167
Its role as a component of first-line
therapy in these diseases is the subject of recently completed and ongoing
randomized trials. 23
Its effectiveness in indolent lymphomas remains uncertain,
although evidence from single institution and registry-based studies suggests that it
may induce longer remissions than those achieved with conventional dose
therapy. 45
Although very few published data exist, the outcome for patients who relapse
after autoSCT appears to be very poor. In a report from the University of Nebraska
Medical Center, the median survival from progression after autoSCT for patients
with NHL was only 3 months, with very few patients surviving beyond 3 years. 6
Attempts at further curative therapy in these patients have included the use of
cytokines such as interferon, monoclonal antibodies, and further high-dose therapy
using either autologous or allogeneic stem cell transplantation. Although
preliminary data suggest that allogeneic transplantation may produce long-term
disease-free survival (DFS) in a small proportion of these patients, most die rapidly
from recurrent disease.
Only limited data are available on patterns of relapse after high-dose therapy
and autoSCT in NHL. Some series, primarily in patients with low-grade
lymphoma, have reported a tendency for recurrence to occur at previously involved
sites. 7
However, similar data have rarely been reported for aggressive NHL, and the
influence of the site or sites of relapse on subsequent outcome has not been
investigated.
We have investigated patterns of relapse after high-dose therapy for NHL in a
series of patients presenting to one institution over an 8-year period, and in a
separate population of patients relapsing after autoSCT who have been reported to
the lymphoma registry of the EBMT.
The aims of the study were to identify patterns of relapse and the incidence of
local and locoregional relapse in patients with NHL receiving high-dose therapy