A Trial of Autologous Bone Marrow Transplantation in a Conventional Room by the Use of a Clean Bed

A Case of Non-Hodgkin's Lymphoma Maintaining Long Term Remission Following Transplantation

Abstract

A 38-yr-old female with diffuse lymphoblastic lymphom of clinical stage III was referred to us for receiving autologous marrow transplantation (Auto-BMT). After confirming no tumor involvement of the marrow, 1.88×10¹⁰ marrow nucleated cells were collected and cryopreserved. shortly after cryopreservation of autologous marrow, she developed relapse and was treated with cyclophosphamide, vincristine and prednisolone with no remarkable effect. Since her disease progressed and became resistant to chemoradiotherapy, marrow-ablative therapy using autologous marrow transplantation was planned. The days before transplantation (day-10), she was isolated in a conventional room facilitated with a “clean bed” and oral non-absorbable antibiotics (GVN: gentamicin. vancomycin and nystatin) were started for total intestinal decontamination. Then she was conditioned with a marrow lethal regimen consisting of high-dose cyclophosphamide (60mg/kg) on days-5 and-4 and 10Gy total body irradiation (CY-TBI regimen). Within 24 hr after conditioning, she was infused with 0.54×10⁸/Kg frozen-thawed bone marrow cells containing 0.60×10⁴/kg granulocyte/macrophage progenitor cells (CFU-C). Hematologic recovery was observed in 3 wk posttransplant and granulocytes recovered from nadir to more than 500/mm³ on day 25. Engraftment was assessed on day 33 by full recovery of hemaotpoiesis. Posttransplant complications including stomatitis due to herpes simplex virus, radiation-induced edema in the neck and mild liver dysfunction resolved with marrow recovery. Severe bacterial infections did not occur despite the use of a conventional room. Complete remission (CR) was confirmed 1 mo posttransplant by re-staging procedures. She is now surviving in unmaintained CR 26 mo after autologous marrow transplantaion (Auto-BMT). It is suggested from our experience that auto-BMT is one of the effective treatment approaches for advanced non-Hodgkin's lymphoma and this treatment procedure can be performed in a conventional room with acceptable risks.