PURGING OF BONE-MARROW IN AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA - A CASE-MATCHED COMPARISON WITH UNPURGED CASES BY THE EUROPEAN BLOOD AND MARROW TRANSPLANT LYMPHOMA REGISTRY

Purpose: The use of in vitro purging of bone marrow in autologous bone marrow transplantation (ABMT) for non-Hodgkin's lymphoma (NHL) has be en a controversial issue; its benefit is as yet unproven. its effect o n the clinical outcome of ABMT in these patients is still unclear. We rook at this issue using data from the European Blood and Marrow Trans plant (EBMT) Lymphoma Registry. Patients and methods: Seventeen hundre d twenty-six patients with NHL have been reported to the EBMT registry , of whom 270 had bone marrow purged at transplant. Two hundred twenty -four of these patients were compared with a case-matched group of 224 unpurged patients who had undergone the same procedure. The case matc hing was made following selection of the main prognostic factors for p rogression-free survival (PFS) by multivariate analysis. Response, com plications, and outcome in ABMT were analyzed. Results: Time to hemato logic engraftment, response to ABMT, and number of procedure-related d eaths were similar in purged and unpurged patients. The overall surviv al (OS) rate was 54% at 5 years in purged patients and 48.3% in unpurg ed patients (P = .1813). The PFS rate was 44.3% and 44.6%, respectivel y (P = .1961). Patterns of relapse, including bone marrow relapse, wer e similar in both groups. Patients with low-grade lymphoma did not hav e a significantly improved PFS if the bone marrow was purged (P = .175 7); however, they did have a significantly improved OS (P = .00184). T his increased OS was found to be associated with non-total body irradi ation (TBI) conditioning and also with the purged patients undergoing transplantation at large transplant centers (P = .0016). Conclusion: P urging of bone marrow in ABMT for NHL does no affect the rate of hemat ologic engraftment or risk of procedure-related death (PRD). There is no significant difference in PFS for patients whose bone marrow is pur ged as compared with unpurged.