Autologous stem-cell transplantation for non-Hodgkin's lymphomas: the role of graft purging and radiotherapy posttransplantation--results of a retrospective analysis on 120 patients autografted in a single institution.

Abstract

This retrospective analysis suggests that marrow purging and posttransplant radiotherapy improve the outcome of patients with NHL autografted in first remission.

Optimal scheduling to reduce morbidity of involved field radiotherapy with transplantation for lymphomas: A Prospective Australasian Leukaemia and Lymphoma Group Study

“…2 Although no completed randomised trial has examined the impact of IFRT added to HDT and AuSCT, several retrospective series have indicated improved outcomes with this strategy. [3][4][5][6][7][8][9][10][11] Important concerns regarding the use of IFRT are its potential toxicity and the logistical constraints in integrating radiotherapy with the overall transplant programme. 12 Two notable forms of toxicity are pneumonitis and haematological toxicity.…”

“…[3][4][5][6][7][8]11 In two studies, the improvement in progressionfree survival associated with the use of IFRT was significant on multivariate analysis. 9,10 Furthermore, in a recent report from the US Autologous Blood and Marrow Transplant Registry, multivariate analysis demonstrated that patients who received radiotherapy experienced a reduced relative risk of death. 11 Nonetheless, the optimal method and timing of IFRT with AuSCT remains to be defined.…”

“…9,17,[44][45][46] Lumbar and pelvic radiotherapy in particular produces the greatest marrow insult, and it is difficult to irradiate large infradiaphragmatic volumes following transplantation because of limiting haematological toxicity. 17 In a recent prospective trial in which IFRT was to be given post transplant, approximately one-quarter of transplanted patients did not receive IFRT due to haematological toxicity.…”

In vivo purging and relapse prevention following ASCT

“…In vitro purging with anti-B cell monoclonal antibodies typically results in a 2-3 log depletion of tumour cells, 8,9 while treatment of the graft with chemotherapeutic agents such as mafosfamide has resulted in a similar level of depletion. 10 Other techniques have employed positive selection of CD34 + cells with antibodies conjugated to magnetic beads. 11 However, while all of these techniques can reduce the level of tumour cell contamination, the majority of grafts remain PCR positive.…”

“…This is further reflected in the disappointing outcomes experienced with in vitro purged ASCT: studies conducted to date have not been translated in any significant increased survival in patients receiving purged compared with unpurged stem cell grafts. 10,12,13 In vitro purging methods are also invariably associated with substantial cell losses, and are frequently expensive to perform. 14 …”