autologous blood and marrow transplantation - Blog Science ...

168 Chapter 4: Lymphoma
and autoSCT, and to determine subsequent survival in these patients. Potential
factors contributing to local vs. systemic relapse were investigated, as was the
potential value of involved-field radiotherapy given routinely to affected sites at
the time of autoSCT.
PATIENTS AND METHODS
Data from two populations of patients receiving high-dose therapy and autoSCT
for NHL were analyzed.
Group A
Between January 1991 and May 1998, 106 patients with NHL underwent highdose
therapy and autoSCT in the Medical Oncology Unit of the University of
Southampton, U.K. Fifty-seven (54%) of these patients have relapsed after
autoSCT. The patient characteristics for this group are summarized in Table 1.
Most patients (n=91) had diffuse large B cell lymphoma, either de novo (n=78) or
having undergone histologic transformation from previous low-grade disease
(n=13). Eighty-one of the patients were treated in chemosensitive relapse.
High dose and transplantation procedures. Of the total of 106 patients, 97
received BEAM (carmustine, etoposide, cytosine arabinoside, melphalan), two
were treated with BEAC (carmustine, etoposide, cytosine arabinoside, cyclophosphamide),
and the remaining seven patients received high-dose cyclophosphamide
and total body irradiation (TBI). The use of elective involved-field radiotherapy
was restricted to patients with sites of bulk disease (>5 cm) at the time of the
relapse before high-dose therapy, unless the patient was receiving TBI-based highdose
therapy or the site had been previously irradiated. Seven patients, all with
primary mediastinal lymphoma, received involved-field radiotherapy, commencing
within 45 days of the stem cell reinfusion.
The source of hematopoietic stem cells was bone marrow in 24 and peripheral blood
progenitor cells (PBPCs) in 82 patients. None of the stem cell products underwent
positive stem cell selection. Purging with anti-B cell monoclonal antibodies was
undertaken in four patients with low-grade NHL as part of a phase U study.
All patients received antimicrobial and blood product support according to
established protocols. The routine use of granulocyte colony-stimulating factor (G-
CSF) after stem cell reinfusion was introduced for the last 2 years of the study period.
Assessment of response. Response to high-dose therapy was assessed at 90 days
after stem cell reinfusion. Complete response was defined as the disappearance of
all clinical evidence of disease, with normalization of all previously abnormal
laboratory and radiological investigations. Partial response was defined as a
reduction by at least 50% in the sums of the products of the biperpendicular