autologous blood and marrow transplantation - Blog Science ...

170 Chapter 4: Lymphoma
Local or locoregional relapse was defined as a relapse occurring in a lymph
node region or extranodal site that had been previously involved or in an
immediately contiguous site. Distant relapse was defined as relapse occurring at
sites other than local or locoregional sites. Patients who relapsed synchronously at
local and distant sites were identified separately from the other two categories.
Treatment at relapse. None of the patients relapsing after autoSCT were treated
with curative intent. Therapy was determined by patient and physician preference.
Localized relapses at previously unirradiated sites were treated with involved-field
radiotherapy (nine patients). Some patients with disseminated disease at relapse
declined further therapy (n=9). The remaining patients were treated with corticos­
teroids alone, single-agent—or low dose combination—chemotherapy, or a
combination of these.
Group B
The lymphoma registry of the EBMT was searched, and patients undergoing
high-dose therapy and autoSCT for NHL were identified. In addition, a small number
of patients undergoing allogeneic bone marrow transplantation were included in this
analysis. Of the total of 11,883 patients, 3454 patients who had relapsed after SCT
were identified. Of these, data concerning sites of relapse were available for 1339. An
initial comparison of these 1339 patients with those on whom relapse sites were not
available showed no difference in the distribution of major demographic or
prognostic features. The characteristics of these patients are shown in Table 2.
High-dose therapy and transplantation procedures. Chemotherapy-only highdose
regimens were used in 749 patients, and chemotherapy plus TBI-containing
regimens were used in 590. The precise regimens varied according to the active
protocols of the participating institutions. The source of autologous hematopoietic
stem cells was bone marrow in 753, peripheral blood in 420, and both in 61. In
addition, 105 patients receiving allogeneic stem cells from HLA-identical sibling
donors were identified.
Positive stem cell selection was used in 16 patients. Purging of stem cell
products was performed in 87 patients, using 4-hydroperoxycyclophosphamide
(4HC) in 30 and antibody-based methods in 57.
All patients underwent high-dose therapy in registered transplant centers.
Supportive measures including antibiotic and blood product support were given
according to the active protocols of the centers, as were hematopoietic growth factors.
Definition of relapse/progression and relapse sites. The definition of relapse or
progressive disease was the same as for group A. The definition of relapse sites was
also the same, except that group B patients with synchronous relapses at local and
distant sites were included in the distant relapse category. Insufficient data on
treatment after relapse were available to allow analysis of its effectiveness.