INTENSIVE THERAPY WITH PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION IN 60 PATIENTS WITH POOR-PROGNOSIS FOLLICULAR LYMPHOMA

Intensive therapy, mainly with purged autologous bone marrow transplan tation (ABMT), has been proposed in recent years as consolidation trea tment in young patients with follicular lymphoma. Reported experience with transplantation of peripheral blood progenitor cells (PBPC) is, s o far, limited. The feasibility and the therapeutic efficacy of intens ive therapy followed by unpurged autologous PBPC reinfusion were evalu ated in 60 patients with poor-prognosis follicular lymphoma. Twelve pa tients were in first partial remission (PR), 34 were in second partial or complete remission (CR), and 14 were in subsequent progression. At the time of the procedure, 39 patients (65%) had persistent bone marr ow involvement, 49 patients (82%) were in PR, and 16 patients had pres ented with a histologic transformation (HT). PBPC were collected after chemotherapy followed by granulocyte (G) colony-stimulating factor (C SF) or granulocyte-macrophage (GM)-CSF in 50 patients. Conditioning re gimens included high-dose chemotherapy alone (14 patients); mainly the BCNU, etoposide, aracytine, melphalan [BEAM] regimen), or cyclophosph amide with or without etoposide plus total body irradiation (46 patien ts). The median time to reach a neutrophil count greater than 0.5 x 10 (9)/L was 13 days. There were five treatment-related deaths, with four being associated with a delayed engraftment and all occurring in pati ents in third or subsequent progression. At a median follow-up of 21 m onths, 48 patients were still alive, 18 relapsed, and seven died of ly mphoma progression. Estimated 2-year overall survival (OS) and failure -free survival (FFS) rates were 86% and 53%, respectively, without a p lateau. Patients treated in PR1 or PR2/CR2 had a significantly longer rate of OS and FFS than those treated in subsequent progression (P = . 002 and P = .001, respectively), whereas age, response to salvage trea tment, presence or absence of residual bone marrow involvement, or con ditioning regimen had no influence on outcome. Patients with HT tended to have a worse FFS rate (P = .04) without an OS difference. Along wi th an unusual rate of engraftment failure, the poor FFS observed in he avily pretreated patients suggests that intensive therapy should be pe rformed early in the course of the disease. Given the high percentage of patients intensified in PR with residual bone marrow involvement, o ur results are comparable with those achieved with ABMT published to d ate. Prospective trials are warranted to compare this strategy with st andard therapy in patients with relapsing or PR follicular lymphoma. ( C) 1995 by The American Society of Hematology.