Randomized trial of peripheral blood progenitor cell vs bone marrow as hematopoietic support for high-dose chemotherapy in patients with non-Hodgkin's lymphoma and Hodgkin's disease: a clinical and molecular analysis

Filgrastim (r-metHuG-CSF)-mobilized peripheral blood progenitor cells (PBPC ) and unstimulated bone marrow (BM) were evaluated and compared for reconst itution after high-dose chemotherapy in patients with relapsed Hodgkin's di sease (HD) or non-Hodgkin's lymphoma (NHL) with respect to engraftment, ove rall and relapse-free survival, and contamination by lymphoma cells using m olecular analysis of immunoglobulin gene rearrangements, Forty-four patient s with either NHL or HD underwent autologous transplantation after high-dos e chemotherapy, Patients were randomized to receive either Filgrastim-mobil ized PBPC (It = 15) or unstimulated BM (n = 14). An additional 15 patients received PBPC without randomization because of a recent history of marrow i nvolvement by lymphoma. Use of PBPC was associated with faster neutrophil e ngraftment than BM (11 vs 14 days to an absolute neutrophil count >0.5 x 10 (9)/l, P = 0.04), but without any difference in platelet engraftment, infec tious complications, or overall or event-free survival. Both BR I (65%) and PBPC (73%) were frequently contaminated by tumor cells as assessed by CDR3 analysis. Patients with negative polymerase chain reaction analysis of a B M sample during the study had a trend towards an improved survival; however , BM involvement by disease had no impact on the ability to mobilize or col lect PBPC, We conclude that PBPC are as effective as BM in reconstituting h ematopoiesis after high-dose chemotherapy and that both products are freque ntly contaminated by sequences marking the malignant clone.