autologous blood and marrow transplantation - Blog Science ...

Molecular Remission: A Worthwhile Aim?
J. Aposolidis, A.Z.S. Rohatiner, R. Gupta, K. Summer
J. Matthews, T.A. Lister
ICRF Medical Oncology Unit, Department of Medical Oncology;
St. Bartholomew's Hospital, London, U.K.
Between 1985 and 1995, 99 patients with follicular lymphoma received highdose
treatment (cyclophosphamide: 60 mg X 2 and total-body irradiation: 200 cGy
X 6) with autologous bone marrow transplantation, as consolidation of 2nd or
subsequent remission. The bone marrow mononuclear cell fraction was treated in
vitro with three cycles of one (74 patients) or four (25 patients) anti-B cell
monoclonal antibodies and complement. Thirty-three patients have developed
recurrent lymphoma, outcome correlating with the histology at the time of
recurrence (follicular, or transformed to a higher grade histology), patients with
transformation having a worse survival (/'=0.01). PCR analysis for t(14;18)containing
cells was performed on bone marrow samples before and after in vitro
treatment. PCR status of reinfused cells did not correlate with freedom from
recurrence (FFR) (P=0.17). However, there was a significant correlation between
FFR and PCR status when follow-up bone marrow samples were analyzed, 19/23
patients with consistently negative samples remaining disease-free compared with
13/30 patients with persistently positive or variable results (P=0.04). Thus
"molecular remission" appears to be a worthwhile aim but longer follow-up is
needed, and these results should be seen in the context of other treatments such as
fludarabine-containing regimens and antibody therapy, which also results in
"molecular remission" being achieved in a proportion of patients.
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