Prolonged Disease-Free Survival after Autografting for Chemosensitive Non-Bulky Low Grade Non-Hodgkin's Lymphoma

Abstract

The results of autografting in patients with relapsed low grade non-Hodgkin's Lymphoma (NHL) have generally been disappointing due to the failure to maintain remission and the late development of myelodysplasia. Most series have used regimens that include total body irradiation and purged stem cells. We evaluated the outcome in 32 patients with low grade NHL autografted using chemotherapy-only busulfan-based conditioning and unpurged stem cells. Seven of 10 patients with poor prognostic features at diagnosis remain alive in CR a median of 78 months (range 14-129) post-transplant. Twenty two patients with relapsed, chemosensitive, low bulk disease, most of whom did not have marrow involvement or an elevated LDH, were transplanted. Only five of the 22 have relapsed, with an 86 ± 8% overall survival and 72 ± 10% event free survival (EFS) after a median follow-up of 56.5 months. All but one patient has an EFS period longer, often substantially so, than their previous longest remission. No patient has developed myelodysplasia. These data suggest that in selected patients with poor prognosis or relapsed low grade NHL autografting has a favourable impact on the natural history of their disease and may result in long-term disease control.