Prognostic factors in patients who received autologous bone marrow transplantation for non-Hodgkin's lymphoma. Report of 104 patients from the Spanish Cooperative Group GEL/TAMO
Conde, E.; Sierra, J.; Iriondo, A.; Domingo, A.; García Laraña, J.; Marín, J.; Caballero, D.; Martínez, F.; León, A.; García-Conde, J.
Bone Marrow Transplantation 14(2): 279-286
1994
ISSN/ISBN: 0268-3369 PMID: 7994243 Document Number: 432753
One hundred and four patients with low grade (9 patients), intermediate grade (31 patients) and high grade (64 patients) non-Hodgkin's lymphoma received an autologous bone marrow transplantation (BMT). Disease status at transplant was first complete remission (CR) in 46 patients, second CR in 14 patients, third CR in 7 patients, chemosensitive disease in 16 patients and chemoresistant disease in 21 patients. Estimated 5 year disease-free survival (DFS) for all 104 patients was 49% (95% confidence interval (CI), 36-63%) with a median follow-up of 24 months. Five year relapse rate for 80 evaluable patients was 26% (95% CI, 14-44%). The 8 year DFS and relapse for the 46 patients transplanted in first CR were 75% (95% CI, 63-82%) and 15% (95% CI, 7-33%), respectively, with a median follow-up of 27 months (range 13-104 months) and a median time to relapse of 5 months (range 4-20 months). In the univariate analysis, variables correlated with DFS were performance status at autologous BMT, disease status at autologous BMT, LDH level at autologous BMT, failure to achieve CR at diagnosis, front-line chemotherapy (1 vs 2 or more regimens) and Working Formulation. Variables correlated with relapse were disease status at autologous BMT, preparative regimen and Coiffer's index at diagnosis. Multivariate analysis showed that performance status was the only independent predictor of DFS and that disease status at autologous BMT was the best relapse predicting variable. In patients transplanted in first CR, the variables correlated with DFS were stage at diagnosis and performance status at autologous BMT. LDH level at diagnosis was the only variable correlated with relapse in patients transplanted in first CR. The overall mortality was 45% (47 of 104). Twenty-eight patients (27%) died because of lymphoma and the remaining 19 (18%) as a result of toxicity. Among patients in first CR, 5 (10.8%) died in relapse and the other 5 because of toxicity. This series confirms the fact that the outcome of autologous BMT is better when performed early in the course of the disease. It is also noteworthy that well-known prognostic parameters at diagnosis which identify patients not likely to be cured with conventional chemotherapy (namely, stage and LDH level) are also associated with a poor outcome after transplant in patients in first CR.