High-dose therapy supported with immunomagnetic purged autologous bone marrow in high-grade B cell non-Hodgkin's lymphoma

From August 1987 to March 1995, 25 patients with high-grade B cell non-Hodg kin's lymphoma (NHL) were treated with high-dose therapy (HDT) followed by bone marrow purged with immunomagnetic beads. At the time of transplantatio n, 20 patients were in sensitive relapse and five in first complete or part ial remission. Ten patients had secondary high-grade NHL transformed from l ow-grade NHL. The HDT consisted of TBI followed by high-dose cyclophosphami de. All patients engrafted, except for two patients with early treatment-re lated death. Eleven patients relapsed, of whom nine died of lymphoma, and t wo are alive in new CR, The estimated event-free and overall survivals at 5 years were 40% and 48%, respectively, with a median followup of 48 months (range 1-123). Eight of the tumours contained the translocation t(14;18) at the major breakpoint region (MBR) of BCL-2. In these patients the presence of tumour cells in the bone marrow graft before and after purging were ass essed by PCR. Four of five patients infused with non-detectable minimal res idual disease in their autografts are in complete remission, while two of t hree patients reinfused with t(14;18) positive cells after purging, experie nced a fast and aggressive relapse. As found by others, our data suggest th at reinfusion of tumour-free autografts obtained by efficient in vivo purgi ng using chemotherapy before harvesting, and/or by in vitro purging of the stem cell products, influence the patients remission status after HDT.