Originally published as JCO Early Release 10.1200/JCO.2006.09.8327 on May 21 2007

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Myeloablative Therapy With Autologous Bone Marrow Transplantation for Follicular Lymphoma at the Time of Second or Subsequent Remission: Long-Term Follow-Up

Ama Z.S. Rohatiner, Lee Nadler, Andrew J. Davies, John Apostolidis, Donna Neuberg, Janet Matthews, John G. Gribben, Peter M. Mauch, T. Andrew Lister, Arnold S. Freedman

From the Cancer Research UK Medical Oncology Unit, St Bartholomew's Hospital, London, United Kingdom; and the Department of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Ama Z.S. Rohatiner, MD, FRCP, Cancer Research UK Medical Oncology Unit, St Bartholomew's Hospital, 45 Little Britain, London EC1A 7BE; e-mail: ama.rohatiner{at}cancer.org.uk

Purpose: The aim of this retrospective analysis was to determine the outcome of patients with follicular lymphoma who received myeloablative therapy supported by autologous bone marrow transplantation as consolidation of second or subsequent remission, with a minimum follow-up of 12 years.

Patients and Methods: One hundred twenty-one adults received cyclophosphamide (CY) and total-body irradiation (TBI) supported by autologous bone marrow transplantation, with the marrow mononuclear cell fraction having been treated with monoclonal antibodies and complement. Data from St Bartholomew's Hospital and Dana-Farber Cancer Institute were combined for the purpose of this analysis because the patients were treated in an identical manner.

Results: Fifty-seven patients are alive, 41 without progression between 9 and 19 years; 64 patients have died, 20 without progression. With a median follow-up of 13.5 years, 60 patients have developed recurrent lymphoma. There is an apparent plateau on the remission duration curve at 48% at 12 years. Survival of patients treated in second remission was significantly longer than the survival of patients treated later in the course of the illness. Both remission duration and overall survival were also significantly longer for patients treated in second remission compared with an age-matched, remission-matched group of patients treated at St Bartholomew's Hospital before the introduction of this treatment. However, use of CY+TBI was associated with a significant risk of secondary myelodysplasia and secondary acute myeloblastic leukemia, resulting in 15 patient deaths.

Conclusion: These mature data confirm that prolonged freedom from recurrence may be achieved with myeloablative therapy and that a plateau on the curve seems to emerge with long follow-up.

published online ahead of print at www.jco.org on May 21, 2007.

Supported by Cancer Research UK.

Presented in part at the 9th International Conference on Malignant Lymphoma, June 8-11, 2005, Lugano, Switzerland.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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