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Autologous Transplantation for Aggressive Non-Hodgkin’s Lymphoma: Results of a Randomized Trial Evaluating Graft Source and Minimal Residual Disease

From the Departments of Internal Medicine, Anatomy and Cell Biology, Pathology and Microbiology, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE; Indiana University Medical Center, Indianapolis, IN; Queens Medical Center, Honolulu, HI; Mayo Clinic, Rochester, MN; and Rocky Mountain Cancer Center, Denver, CO.

Address reprint requests to Julie M. Vose, MD, Department of Internal Medicine, Section of Hematology/Oncology, University of Nebraska Medical Center, 600 S 42nd St, Omaha, NE 69198; email: jmvose{at}unmc.edu

PURPOSE: To determine whether the source of autologous hematopoietic stem cells altered the clinical outcomes of patients undergoing high-dose chemotherapy and hematopoietic stem-cell transplantation (HSCT) for aggressive non-Hodgkin’s lymphoma (NHL).

PATIENTS AND METHODS: Of 105 high-risk, persistent, or relapsed NHL patients slated for an autologous HSCT entered onto this trial, 93 eligible patients were randomized to receive cytokine-naive autologous bone marrow transplantation (ABMT) (n = 46) or mobilized peripheral-blood stem-cell transplantation (PBSCT) (n = 47). All patients received carmustine, etoposide, cytarabine, and cyclophosphamide as the conditioning regimen. PBSCT patients also received identical mobilization with granulocyte colony-stimulating factor (G-CSF) 10 µg/kg/d, and both groups received G-CSF 5 µg/kg/d after the infusion of the stem-cell product until neutrophil engraftment.

RESULTS: PBSCT patients had significantly faster engraftment of all cell lineages: median time to absolute neutrophil count 500/µL, 10 days versus 13 days on the ABMT arm; median time to platelet count greater than 20,000/µL untransfused, 11 days versus 15 days on the ABMT arm; and median time to RBC transfusion independence, 8 days versus 16 days on the ABMT arm. The complete response rate was 72% for PBSCT and 54% for ABMT. The death rate before posttransplant day 100 was 2% on the ABMT arm and 6% on PBSCT arm. Event-free survival was 37% for PBSCT and 37% for ABMT. However, overall survival for PBSCT was 61% compared with 43% for ABMT.

CONCLUSION: Patients with aggressive NHL receiving HSCT randomized to PBSCT demonstrated improved neutrophil engraftment and platelet and RBC transfusion independence. The complete response rate and EFS were not statistically different by randomization arm. Patients whose harvests were positive for minimal residual disease by molecular analysis had poorer EFS.

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