The role of molecular monitoring in autotransplantation for non-Hodgkin's lymphoma

Bone Marrow Transplant. 2002 Apr;29(7):581-7. doi: 10.1038/sj.bmt.1703422.

Abstract

Seventy-two patients with non-Hodgkin's lymphoma were evaluated for the presence of molecular markers (IgH, bcl-1, bcl-2 rearrangement) on bone marrow, at diagnosis and after PBSCT, and on harvests in order to find a possible predictive role of minimal residual disease on treatment outcome. At diagnosis, 41 (59%) out of 69 available bone marrows showed molecular involvement. Fifty-six percent of leukaphereses were involved, mainly indolent lymphoma (P = 0.001) or advanced disease (P = 0.01). Ex vivo purging cleared only one stem collection out of 31 PCR-positive leukaphereses. Aggressive lymphomas showed both a longer overall survival (OS) (P = 0.03) and relapse-free survival RFS (P = 0.02) when transplanted with unpurged stem cells, whereas indolent NHL survival was not influenced by ex vivo purging. Twenty out of 26 samples taken during follow-up had bone marrow involvement at diagnosis. Of these, 15 cleared their bone marrow; both OS and RFS were significantly longer in the PCR-negative cases (P = 0.05 and P = 0.005). At 1 year after PBSCT, 75% of patients were PCR negative, with 50% molecular remissions; the relapse rate was 55% for patients still PCR positive vs 29% for those who were PCR negative. Thus, after high-dose chemotherapy, close molecular monitoring of MRD using qualitative PCR techniques seems to represent a reliable prognostic indicator.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biomarkers, Tumor / analysis*
  • Bone Marrow / chemistry*
  • Bone Marrow Purging
  • Combined Modality Therapy
  • Cyclin D1 / analysis*
  • Cyclin D1 / genetics
  • Cyclophosphamide / administration & dosage
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Female
  • Follow-Up Studies
  • Genes, bcl-2
  • Humans
  • Immunoglobulin Heavy Chains / analysis*
  • Immunoglobulin Heavy Chains / genetics
  • Leukapheresis
  • Life Tables
  • Lymphoma, Non-Hodgkin / chemistry*
  • Lymphoma, Non-Hodgkin / drug therapy
  • Lymphoma, Non-Hodgkin / mortality
  • Lymphoma, Non-Hodgkin / pathology
  • Lymphoma, Non-Hodgkin / therapy
  • Male
  • Middle Aged
  • Neoplasm Proteins / analysis*
  • Neoplasm, Residual
  • Polymerase Chain Reaction
  • Predictive Value of Tests
  • Prednisone / administration & dosage
  • Proto-Oncogene Proteins c-bcl-2 / analysis*
  • Proto-Oncogene Proteins c-bcl-2 / genetics
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Vincristine / administration & dosage

Substances

  • Biomarkers, Tumor
  • Immunoglobulin Heavy Chains
  • Neoplasm Proteins
  • Proto-Oncogene Proteins c-bcl-2
  • Cyclin D1
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol