PubMed · 8695876
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A M Gewirtz, S M Luger, E Stadtmauer. 1996-08-15. Bone marrow purging with oligodeoxynucleotides.. https://pubmed.ncbi.nlm.nih.gov/8695876/
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PURPOSE: Contribution of peripheral blood stem cell (PBSC) contaminating tumor cells to subsequent relapse and overall survival of neuroblastoma patients remains controversial. EXPERIMENTAL DESIGN: Neuroblastoma cell contamination of 27 PBSC harvests from stage IV neuroblastoma patients was assessed by quantitative RT-PCR for both tyrosine hydroxylase (TH) and GD2 synthase (GD2-s). The effect of PBSC contamination on survival was then analyzed. RESULTS: Seven PBSC tested negative for both markers; 19 were positive for GD2-s, 6 for TH, with 5 positive for both. Survival of the 20 patients with positive PBSC did not differ from that of the patients with negative PBSC (log-rank test, P = 0.134 and 0.218 for event-free survival and overall survival, respectively). By considering the TH and GD2-s results independently, a borderline (P = 0.053) negative effect on event-free survival was observed in patients reinfused with GD2-s-positive PBSC. When the status at transplant was taken into account, only the event-free survival of the patients rescued when in complete remission with GD2-s-negative PBSC was better, although not significantly, than that of patients infused with GD2-s-positive PBSC. CONCLUSIONS: Our results obtained in a small cohort of homogeneously treated stage IV patients suggest that patient survival is not affected by PBSC contamination with the exception of a borderline negative effect on event-free survival in patients rescued when in complete remission.
Treatment options for follicular lymphoma have expanded dramatically. The most important relate to the introduction of monoclonal antibodies and the completion of important studies regarding autologous and allogeneic transplantation. The EBMTR-sponsored "CUP Trial" (conventional Chemotherapy, Unpurged autograft, Purged autograft), demonstrated that for patients under age 60 years with recurrent chemotherapy-sensitive disease, autologous stem cell transplantation (ASCT) provides a survival benefit over conventional therapy. Three randomized studies demonstrated that consolidation with autologous transplantation in first remission leads to improvement in progression free survival and perhaps in overall survival, but possibly with an increased risk for secondary MDS. Novel approaches involve the incorporation of rituximab as an in-vivo purging agent or as post-transplant therapy, and the use of radiolabelled monoclonals in the conditioning regimens. Allogeneic stem cell transplantation (alloSCT) has become a more effective option but continues to have a high TRM. Reduced-intensity alloSCT procedures now are being performed at an increasing rate and may have advantages in particular situations. A CIBMTR analysis unfortunately did not show a major advantage in terms of TRM or EFS to non-myeloablative transplantation. Performance status and disease sensitivity remain the major predictors of outcome for allogeneic transplantation.
Long-term disease-free survival (DFS) has been reported after autologous stem cell transplantation for acute lymphoblastic leukemia. Phase II studies have evaluated its role in first and subsequent complete remission (CR) with DFS rates of up to 50%. It has been under-utilized in 1st CR in part, due to a concern that patients who relapse after autologous stem cell transplantation (ASCT) have fewer options for salvage treatment of relapsed disease. Unfortunately, survival rates of <5% are reported in patients who relapse, regardless of initial therapy. Few prospective, randomized trials have analyzed large enough numbers of patients to allow us to determine the appropriate patient population for autologous transplantation. Although variability in the available studies makes it difficult to draw a definite conclusion, and many issues remain unresolved, available data suggests that there may be a group of patients for whom ASCT in first remission is a reasonable and perhaps superior treatment choice. Factors such as risk features at diagnosis, and minimal residual disease following induction therapy greatly affect outcome following ASCT. The available data as well as the questions that remain to be answered will be discussed and reviewed.