Autologous transplantation for aggressive non-Hodgkin's lymphoma: Results of a randomized trial evaluating graft source and minimal residual disease

Julie M. Vose, Graham Sharp, Wing C. Chan, Craig Nichols, Kevin Loh, David Inwards, Robert Rifkin, Philip J. Bierman, James C. Lynch, Dennis D. Weisenburger, Anne Kessinger, James O. Armitage

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2344-2352
Number of pages9
JournalJournal of Clinical Oncology
Volume20
Issue number9
DOIs
StatePublished - May 1 2002

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Peripheral Blood Stem Cell Transplantation
Autologous Transplantation
Residual Neoplasm
Non-Hodgkin's Lymphoma
Bone Marrow Transplantation
Transplants
Hematopoietic Stem Cell Transplantation
Arm
Neutrophils
Granulocyte Colony-Stimulating Factor
Carmustine
Platelet Transfusion
Cytarabine
Cell Lineage
Etoposide
Random Allocation
Hematopoietic Stem Cells
Platelet Count
Cyclophosphamide
Disease-Free Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Autologous transplantation for aggressive non-Hodgkin's lymphoma : Results of a randomized trial evaluating graft source and minimal residual disease. / Vose, Julie M.; Sharp, Graham; Chan, Wing C.; Nichols, Craig; Loh, Kevin; Inwards, David; Rifkin, Robert; Bierman, Philip J.; Lynch, James C.; Weisenburger, Dennis D.; Kessinger, Anne; Armitage, James O.

In: Journal of Clinical Oncology, Vol. 20, No. 9, 01.05.2002, p. 2344-2352.

Research output: Contribution to journalArticle

Vose, Julie M. ; Sharp, Graham ; Chan, Wing C. ; Nichols, Craig ; Loh, Kevin ; Inwards, David ; Rifkin, Robert ; Bierman, Philip J. ; Lynch, James C. ; Weisenburger, Dennis D. ; Kessinger, Anne ; Armitage, James O. / Autologous transplantation for aggressive non-Hodgkin's lymphoma : Results of a randomized trial evaluating graft source and minimal residual disease. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 9. pp. 2344-2352.
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abstract = "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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T2 - Results of a randomized trial evaluating graft source and minimal residual disease

AU - Vose, Julie M.

AU - Sharp, Graham

AU - Chan, Wing C.

AU - Nichols, Craig

AU - Loh, Kevin

AU - Inwards, David

AU - Rifkin, Robert

AU - Bierman, Philip J.

AU - Lynch, James C.

AU - Weisenburger, Dennis D.

AU - Kessinger, Anne

AU - Armitage, James O.

PY - 2002/5/1

Y1 - 2002/5/1

N2 - 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.

AB - 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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