VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

Crouse, 1992).
In the present report we update the clinical outcome of 65 patients with non-
Hodgkin's lymphoma 20 of whom received autologous peripheral blood derived
stem cell transplantation (PSCT) largely because their marrow was histologically
and culture positive for lymphoma and 45 who received autologous
bone marrow transplantation (ABMT). The ABMT patients received histologically
negative marrows, however in 17 instances these marrows were culture
positive for lymphoma. In addition, we present the outcome for 29 patients with
breast cancer or other gynecological epithelial tumors whose marrow was histologically
and/or culture positive for tumor cells and therefore, with the exception
of one patient who died before transplant, they underwent PSCT. Culture
studies evaluated retrospectively showed that 6 patients had apheresis harvests
that grew abnormal, suspected epithelial tumor cells, 23 did not. The results
overall demonstrate that imnimal contamination of hematopoietic harvests is an
important determinant of outcome of high dose therapy and hematopoietic cell
transplantation.
MATERIALS AND METHODS
Bone marrow and/or peripheral blood stem cell harvests obtained by
leukapheresis were examined histologically or cytologically, respectively, for the
presence of tumor cells. Aliquots of these harvests were then placed into culture
as described previously for non-Hodgkin's lymphoma patient samples (Sharp et
al., 1991; Sharp et al., 1992) or breast cancer patient harvests (Sharp and Crouse,
1992) and aliquots obtained at various times subsequently and evaluated for the
presence of tumor cells as described previously.
The frequency of tumor cell detection from both histologically and cytologically
positive and negative harvests was noted. In addition clinical outcome in
terms of whether or not patients achieved a complete remission (CR) when restaged
at 100 days was noted and for those patients receiving a CR at 100 days,
the time to subsequent disease progression was recorded. These data were then
analyzed to determine the influence of tumor cells detected histologically or cytologically
or by culture techniques, or both, on clinical outcome.
All of the protocols employed were approved by the University of Nebraska
Institutional Review Board and patients voluntarily signed informed consent for
these studies.
RESULTS AND DISCUSSION
Non-Hodgkin's Lymphoma: A total of 65 patients have now been followed
for a median of 3 years with actuarial follow-up predicted to 5 years. Of these 65
patients 45 who had histologically negative marrows underwent ABMT. However
17 of these patients had culture positive marrows, 27 culture negative marrows
and one was unevaluable. The remaining 20 patients had either histologically
positive (19) or hypocellular (1) marrows and underwent PSCT. Two had
tumor culture and/or molecular biology positive apheresis harvests, 18 were
negative.
All grades of lymphoma were included since our experience suggests that
primary refractory or relapsed low grade lymphoma patients have a poor outcome
similar to the same categories of intermediate and high grade lymphoma
224 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION