Abstract

Disseminated low grade non Hodgkin's lymphomas cannot be cured with current standard treatments and there is a growing interest in the use of more intensive approaches. The rationale for applying myelo ablative therapy and stem cell rescue relies on the extreme sensitivity of low grade lymphoma to both radiation and repeated courses of alkylating agents. Intensive chemotherapy with or without total body irradiation is usually attempted after first or subsequent relapses. Allogenic bone marrow transplantation is usually preferred for patients with small lymphocytic lymphoma/chronic lymphocytic leukaemia with poor prognostic features. Autologous bone marrow or peripheral blood stem cells are more commonly used in follicular lymphomas. Some studies using autologous bone marrow apply different methods of purging in an attempt to eliminate the risk of infusing contaminated tumour cells. Patients receiving bone marrow, which has been purged with anti-B cell monoclonal antibodies and complement and shows no evidence of malignant cells by polymerase chain reaction (PCR) to bcl-2 rearrangement seem to have a markedly improved disease free survival. However, the actual significance of PCR positivity to bcl-2 rearrangement in bone marrow or peripheral blood is still unclear. Published experience using high dose therapy and stem cell rescue in low grade lymphoma indicates that intensive approaches increase disease free survival, but the indolent nature and relapsing behaviour of these lymphomas requires longer follow up. Also new, well designed and controlled studies directed at measuring the impact of different variables such as patient selection, rescue product and purging are still needed before any definite conclusion can be obtained.

Original languageEnglish (US)
Pages (from-to)599-606
Number of pages8
JournalFORUM - Trends in Experimental and Clinical Medicine
Volume5
Issue number6
StatePublished - Dec 1 1995

Keywords

  • Bone marrow transplantation
  • Low-grade non-Hodgkin's lymphoma

ASJC Scopus subject areas

  • Medicine(all)

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