Can we identify patients with low grade lymphoma for frontline ABMT?

Autologous Bone Marrow Transplant (ABMT), at this point, is an experimental procedure reserved for patients without cure potential with available conventional chemotherapy. Unfortunately, the Ann Arbor staging system has not been able to identify these cases since there are patients with Stage IV who do well and others who do not. We have reported on a risk model based on gender and tumor burden (TB) assessment that can stratify patients with uniform Ann Arbor stage IV follicular low-grade lymphoma (FLGL) into three prognostic groups: (a) a group of females with low TB who have achieved a plateau of failure free survival (FFS) and survival of 50% and 92% respectively, and who should not receive frontline ABMT; (b) a group of males with high TB having a median FFS and survival of only 12 and 48 months, respectively, and who could potentially benefit from ABMT; (c) a large group of patients with other TB-sex combinations, who are continuously relapsing at ten year follow-up, and whose survival is dismal. Even some of these, who have at best a 50% ten year survival, have not reached a plateau in their survival curves. This large group of patients, like all stage IV patients, will have a median age of 60 years at the time of initial diagnosis and treatment, and will be probably over 60 years old by the time they relapse, at which time salvage therapy will have increased morbidity and mortality, more so if it includes ABMT. Therefore, until further data might select patients with better outcome among this last group, they should be offered the option of frontline ABMT as consolidation of a complete remission (CR). All patients who achieved a partial response to initial conventional chemotherapy in our study had poor FFS and survival curves, and should also be candidates for an experimental protocol containing consolidation therapy with ABMT.