High-dose therapy with autologous or allogeneic transplantation as salvagetherapy for small cleaved cell lymphoma of follicular center cell origin

Between 1985 and 1996, 51 patients with relapsed or refractory small cleave d cell lymphoma (SCCL) received high-dose chemotherapy +/- TBI in conjuncti on with autologous (ABMT) (36 patients) or allogeneic transplantation (15 p atients). Patients were eligible for ABMT if the bone marrow biopsy done pr ior to the planned transplant did not reveal microscopic involvement with S CCL, Patients receiving ABMT had a median age of 48 years, had received a m edian of 2.5 chemotherapy regimens prior to transplantation, and were trans planted a median of 35.5 months from diagnosis, Among patients receiving AB MT, 5 year actuarial survival was 56 +/- 11%, Median survival was 126+ mont hs, and median survival from diagnosis was 191 months, Univariate and multi variate analysis identified sensitive disease as the best predictor of a fa vorable response. Five-year actuarial survival was 66 +/- 12% for patients with sensitive disease at the time of transplant as compared to 29 +/- 17% for patients with resistant disease, P = 0.015, Median survival in patients with sensitive disease at the time of ABMT was 126+ months. By univariate analysis, survival was significantly better for patients receiving ABMT as compared to patients receiving allogeneic transplants. Median survival foll owing allogeneic transplantation was 5 months; 5 year actuarial survival wa s 15 +/- 13%, In a multivariate analysis, which considered autologous vs al logeneic transplantation, sensitive vs resistant disease, <3 vs greater tha n or equal to 3 prior treatments, and prior bone marrow involvement, alloge neic transplantation was significantly associated with poor survival. Treat ment-related mortality occurred in eight of 15 patients receiving allogenei c transplantation and limited the effectiveness of this therapy. High-dose therapy in conjunction with ABMT is effective therapy for patients with SCC L whose disease is sensitive to chemotherapy and whose marrows are microsco pically free of disease, Because of possible selection bias, it has not bee n proven that this approach increases survival in these patients, Treatment -related mortality limits the effectiveness of allogeneic transplantation i n SCCL.