[ Main Page | Editorial Board | About | Instructions ]
[ Table of Contents | Archive | Archive Search | Online Submission | Sponsor | E-mail ]

Turkish Journal of Cancer
2007, Volume 37, Number 2, Page(s) 045-053
[ Summary ] [ PDF ] [ Similar Articles ] [ Mail to Editor ]
The autologous hematopoietic stem cell transplantation in adult patients with lymphoma: Turkish Bone Marrow Transplantation Registry results
FİKRET ARPACI1, SELMİN ATAERGİN1, GÜNHAN GÜRMAN2, SEÇKİN ÇAĞIRGAN3, MUTLU ARAT2, AHMET ÖZET1, MELTEM AYLI4, MUHİT ÖZCAN2, ALİ ÜNAL5, TEOMAN SOYSAL6, YENER KOÇ7, ABDULLAH BÜYÜKÇELİK2, AHMET ÖZTÜRK8, ERCÜMENT OVALI9, HAKAN GÖKER10, BERKSOY ŞAHİN11, SEVGİ KALAYOĞLU BEŞIŞIK12, MAHMUT BAYIK13, ZAHİT BOLAMAN14, SEVİL BAVBEK15
1Gülhane Military Medical Academy, Department of Medical Oncology, Ankara-Turkey
2Ankara University İbn-i Sina Hospital, Department of Hematology and Oncology, Ankara-Turkey
3Ege University Medical School, Department of Hematology, İzmir-Turkey
4Numune Education and Research Hospital, Department of Hematology, Ankara-Turkey
5Erciyes University Medical School, Department of Hematology and Medical Oncology, Kayseri-Turkey
6İstanbul University Cerrahpaşa Medical School, Department of Hematology, İstanbul-Turkey
7Hacettepe University Institute of Oncology, Department of Medical Oncology, Ankara-Turkey
8Gülhane Military Medical Academy Haydarpaşa Hospital, Department of Hematology and Medical Oncology, İstanbul-Turkey
9Karadeniz Technical University Faculty of Medicine, Department of Hematology, Trabzon-Turkey
10Hacettepe University Faculty of Medicine, Department of Hematology and BMT Unit, Ankara-Turkey
11Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana-Turkey
12İstanbul University Faculty of Medicine, Department of Hematology, İstanbul-Turkey
13Marmara University Faculty of Medicine, Department of Hematology and Immunology, İstanbul-Turkey
14Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın-Turkey
15İstanbul University Institute of Oncology, Department of Medical Oncology, İstanbu-Turkey
Keywords: Registry, lymphoma, autologous stem cell transplantation, Turkish Oncology Group
Summary
Turkish Bone Marrow Transplantation Registry (TBMTR) was established in 1995. Since 1992, data of adult lymphoma patients from fifteen national transplantation centers were collected and analyzed by TBMTR. A total of 437 adult lymphoma patients (185 Hodgkin's and 252 non-Hodgkin's lymphoma) undergoing autologous hematopoietic stem cell transplantation (HSCT) were registered in TBMTR from 1992 to 2002. Peripheral blood as stem cell source was used in 94% of the transplantations. Non-TBI (total body irradiation) conditioning regimens were administered in 88% of the cases. The 100-day transplantation-related mortality (TRM) was 11% in relapsed and 11% in primary refractory Hodgkin's lymphoma patients whilst TRM was found to be 9% and 30% in non-Hodgkin's lymphoma patients in first remission and in primary refractory cases, respectively. Infection was the most common cause of TRM. 10-year and 5-year survival rates were 50% and 49% in relapsed cases and primary refractory cases with Hodgkin's lymphoma, respectively; while in non-Hodgkin's lymphoma patients 10-year survival rate was 65% in cases in first remission, 7-year survival rate was 50% in sensitive relapse, 2-year survival rate was 0% in resistant relapse and 3-year survival was 24% in primary refractory cases. In conclusion, TBMTR results are comparable to EBMT and IBMTR results. Therefore, autologous HSCT may provide long-term survival in patients with Hodgkin's lymphoma as well as in patients with non-Hodgkin lymphoma in first remission and in sensitive relapse. [Turk J Cancer 2007;37(2):45-53]
  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Introduction
    Bone marrow or peripheral blood stem cell trans-plantation (PBSCT) may provide long-term remission and cure for a proportion of patients with Hodgkin's and non-Hodgkin's lymphoma.

    First Turkish allogeneic bone marrow transplantation for lymphomas was commenced in 1987, whereas autologous bone marrow transplantation in 1992 and PBSCT in 1993. The Turkish Bone Marrow Transplantation Registry (TBMTR) was founded in 1995 and nationwide data accumulation for hematopoietic stem cell transplantation (HSCT) has been done since then. A total of 15 centers participate actively in bone marrow and PBSC transplantation activities and report their results regularly to the registry.

    This is the first published report for long-term results of HSCT activity and outcomes in Turkey. Here, we evaluate retrospectively the results of patients with Hodgkin's and non-Hodgkin's lymphoma who underwent autologous transplantation from 1992 until 2002 in Turkish bone marrow transplantation (BMT) centers.

  • Top
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Material and Methods
    Patients
    A total of 511 adult (over 15-years of old) lymphoma patients (185 Hodgkin's and 252 non-Hodgkin's lym-phoma) undergoing HSCT were registered in TBMTR between 1992 and 2002; while of these 511 patients, 74 were excluded due to insufficient data records. Histopathologic subclassification was done according to REAL classification and no patient has received rituximab before transplantation.

    Disease status of the patients before the transplantation were relapse and primary refractory disease for Hodgkin's lymphoma and sensitive relapse, resistant relapse, first complete or partial remission (CR1/PR1) and primary refractory disease for non-Hodgkin's lymphoma patients.

    Data collection
    Each transplantation center in Turkey has been requested to contribute data to the Registry and data of 15 transplantation centers registered in TBMTR were analyzed retrospectively beginning from 1992 to 2002. A standard Med-A form was completed at each center and sent to registry center for each transplantation. The presence or absence of relapse and the disease status of the patient and cause of death was requested to each center in annual basis.

    The date of autologous HSCT was noted as day 0 and follow-up date was the date of the last medical examination.

    Statistical analysis
    Probabilities of 100-day mortality (death from any cause in the first 100 days after transplantation) and overall survival were calculated using SPSS 9.0 statistical software by the method of Kaplan-Meier (SPSS Inc, Chicago, IL, USA). Overall survival was measured from the date of transplantation (stem cell infusion) to the date of death from any cause or the last follow-up evaluation.

  • Top
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Results
    During the 10 years from 1992 to 2002, a total of 511 adult patients with diagnosis of lymphoma were transplanted in Turkey, 437 of whom were eligible for registry.

    Hodgkin's lymphoma
    Patient characteristics for the entire group are shown in table 1. One-hundred and eighty-five patients were Hodgkin's lymphoma with a male to female ratio of 125/60. The median age of the patients was 23 years (range: 15-64). One-hundred and fifty-nine patients out of 185 were relapse cases and 26 out of 185 were primary refractory disease at the time of transplantation. Histopathologic subclassification were mixed cellular (48%), nodular sclerosing (25%), lymphocyte-predominant (13%), lym-phocyte-depleted (7%) and pathology unknown (7%).

    Table 1: Characteristics of patients with Hodgkin's lymphoma

    Non-Hodgkin's lymphoma
    Patients' characteristics are given in table 2. Two-hundred and fifty-two patients were non-Hodgkin's lymphoma. The median age of the patients was 36 years (range: 15-65) with 189 male and 63 female. The histopathologic subtype of the disease was diffuse large B cell (47%), precursor T lymphoblastic (18.8%), mantle cell (6.92%), peripheral T cell (6.92%), anaplastic large cell (5.42%), follicular (4.74%), immunoblastic (4.34%), Burkitt's (3.25%), nodal marginal zone B cell (1.62%), mycosis fungoides (1.08%).

    Table 2: Characteristics of patients with non-Hodgkin's lymphoma

    Hematopoietic stem cell sources and conditioning regimens
    Bone marrow (3%), bone marrow with peripheral blood (<1%), peripheral blood with CD34+ selection (3%) and peripheral blood (94%) were used as sources of hematopoietic stem cells.

    Non-TBI (total body irradiation) conditioning regimens were used in 88% of the transplantations [BEAM (BCNU, etoposide, cytarabine and melphalan) vs. CBV (cyclophosphamide, BCNU, etoposide)], whereas 12% of the patients underwent TBI containing conditioning regimens for lymphoma.

    Outcome
    100-day transplantation-related mortality rate was 11% in all Hodgkin's lymphomas including relapsed and primary refractory cases; whereas the rate was 15% in all non-Hodgkin's lymphomas (9% in CR1/PR1, 13% in sensitive relapse, 22% in primary refractory cases and 3% in resistant relapse) (Table 3).

    Table 3: Transplant-related mortality (TRM) in patients with Hodgkin's and non-Hodgkin's lymphoma

    The main cause of death in all patients was the relapse of the primary disease (86%) in addition to transplantation-related mortality (14%).

    The overall survival rate was 50% in all patients with Hodgkin's lymphoma at 10-year follow-up (Figure 1), 50% in relapsed cases at 10th year (Figure 2) and 49% in primary refractory cases at 5th year (Figure 3); whereas, in patients with non-Hodgkin's lymphoma the overall survival rate at 10th year was 45% in all cases (Figure 4), 65% at 10th year for CR1/PR1 (first complete/partial remission) (Figure 5), 50% at 7th year for sensitive relapse (Figure 6), 24% at 3rd year for primary refractory disease (Figure 7) and 0% at 2nd year for resistant relapse (Figure 8).

    Fig 1: Survival of all patients with Hodgkin's lymphoma

    Fig 2: Survival of patients with Hodgkin's lymphoma with relapse

    Fig 3: Survival of patients with Hodgkin's lymphoma with primary refractory disease

    Fig 4: Survival of all patients with non-Hodgkin's lymphoma

    Fig 5: Survival of patients with non-Hodgkin's lymphoma with CR1/PR1

    Fig 6: Survival of patients with non-Hodgkin's lymphoma with sensitive relapse

    Fig 7: Survival of patients with non-Hodgkin's lymphoma with primary refractory disease

    Fig 8: Survival of patients with non-Hodgkin's lymphoma with resistant relapse

  • Top
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Discussion
    The number of HSCT in Turkey increased rapidly beginning from early 1990 hitherto. The number of transplantations in Hodgkin's lymphoma reached around 43 transplantations per year, whereas 63 transplantations per year were done for non-Hodgkin's lymphoma. After year 2000, the activity of the transplantation has been accelerated (Turkish Transplantation Registry, oral communication).

    It is well known that the majority of patients with advanced Hodgkin's lymphoma can be effectively treated with standard chemotherapy[1]. Unfortunately, patients with primary resistant or relapsed disease have a relatively low chance of cure.

    There are no randomized trials comparing conventional salvage chemotherapy to autologous transplantation in patients with Hodgkin's disease who have not achieved a complete remission with initial therapy. There are only two relatively small randomized clinical trials comparing high-dose with standard-dose chemotherapy in high-risk Hodgkin's lymphoma showing a 4-year event-free survival rate of 50%[2-4]. Some reports have also suggested that patients with Hodgkin's lymphoma with primary refractory disease do less well than those patients who achieved an initial remission to front-line therapy[5].

    In fact, autologous HSCT seems to be the best curative option for patients with relapsed and primary refractory Hodgkin's lymphoma[2,6,7]. Recently, encouraging reports on high-dose chemotherapy in primary refractory Hodgkin's disease have been published worldwide[5,8-11]. Reported 5-year overall survival probability is 35-60% in patients with primary resistant disease and 50-65% in patients who have relapsed after standard therapy[8-12]. Moskowitz et al.[13] found a marked survival advantage with HSCT for patients who have chemosensitive Hodgkin's disease; however overall survival was similar for patients with relapsed or primary refractory disease.

    Our study findings indicate that autologous HSCT can lead to durable remissions in 50% of patients with primary refractory or relapsed Hodgkin's lymphoma patients which is consistent with other study results, as well as with those of ABMTR[8,14,15].

    Anthracycline-based induction chemotherapy pro-duces complete remission rates of 50% to 70% and long-term disease-free survival in approximately 40% of patients with aggressive non-Hodgkin's lymphoma[16, The benefit of autologous HSCT in patients without complete remission by their initial induction chemotherapy is not well defined. GEL/TAMO trial[18] demonstrated a 5-year survival response of 43% in patients who failed to achieve complete remission with front-line conventional chemotherapy. Whereas, the Parma trial[19] is the first study which randomized patients with chemotherapy-sensitive relapsed disease to either standard salvage chemotherapy or autologous HSCT, and demonstrated improved progression-free survival and overall survival in the transplantation group. SWOG phase-II study[20] showed similarly that autologous bone marrow transplantation prolongs survival in relapsed non-Hodgkin's lymphomas. Mills et al.[21] reported a progression-free survival rate of 32% in patients with chemotherapy-sensitive relapsed disease. Many other studies containing small numbers of patients demonstrated progression-free survival rates of 30% to 40% [18,22,23]. Another study from ABMT showed a better outcome in chemotherapy-sensitive disease with a survival rate of 44% at 3-year[24]. Our survival outcome was 50% at 85 month follow-up for patients with sensitive relapse and is comparable to these studies.

    Sensitivity to chemotherapy in relapsed non-Hodgkin's lymphoma is of prognostic significance. Relapse-free survival rate after autologous transplantation was 0-15% in the primary refractory group and 15-30% in the sensitive relapsed group[25]. Philip et al.[26] reported an event-free survival of 10-15%, which is similar to that observed with standard-dose salvage regimens in patients with refractory relapsed non-Hodgkin's lymphoma. Many subsequent studies of transplantation excluded such truly primary refractory patients from transplantation and better results were observed in chemosensitive patients than chemoresistant primary failures[23]. We haven't excluded patients with primary refractory disease from the study and we found a low rate of survival as 24% at 40-month follow-up consistently with these studies.

    Despite controversy, some randomized controlled trials showed positive value for autologous HSCT as an initial treatment for high-intermediate and high-risk non-Hodgkin's lymphoma: the GELA[27] and Milan[28] studies, and the Italian study by Santini et al.[29] reported that high-dose therapy with transplantation improves relapse-free survival and overall survival. This was prospectively confirmed by the recent GOELAMS study[30]. On the other hand, three other studies from an Italian group[31], the German Lymphoma Group[32], and Martelli et al.'s study[33] found no significant difference with respect to relapse-free survival and overall survival. Our results also confirm that early transplantation in the first complete and partial remission may increase the overall survival rate (65%) in aggressive non-Hodgkin's lymphoma.

    With better selection of patients, improved supportive care and the introduction of blood stem cells, the early TRM associated with autologous HSCT has decreased to less than 5%[34,35]. According to ABMTR data, TRM rate is around 5-8% in Hodgkin's lymphoma and around 10% in non-Hodgkin's lymphoma. In our study, TRM was 11% in Hodgkin's and 15% in all non-Hodgkin's lymphoma cases. These rates are consistent with the results of international registries.

    In summary, autologous HSCT leads to durable remission in the majority of patients with Hodgkin's disease and non-Hodgkin's lymphoma. However, chemoresistant relapsed and primary refractory patients with non-Hodgkin's lymphoma have a poorer survival than chemosensitive patients. Our transplantation results on lymphomas are similar to other single or multicenter study results.

    ACKNOWLEDGEMENT
    We are grateful to Dr. Mustafa Turan from Gülhane Military Medical Academy, Department of Hydroclimatology for helping us in statistical analysis.

  • Top
  • Introduction
  • Methods
  • Results
  • Discussion
  • References
  • References

    1) Diehl V, Franklin J, Pfreundschuh M, et al. German Hodgkin's Lymphoma Study Group. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med 2003;348:2386-95.

    2) Linch DC, Winfield D, Goldstone AH, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet 1993;341:1051-4.

    3) Schmitz N, Pfistner B, Sextro M, et al. German Hodgkin's Lymphoma Study Group; Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet 2002;359:2065-71.

    4) Yuen AR, Rosenberg SA, Hoppe RT, et al. Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin's disease. Blood 1997;89:814-22.

    5) Sweetenham JW, Carella AM, Taghipour G, et al. High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: results in 175 patients reported to the European Group for Blood and Marrow Transplantation. Lymphoma Working Party. J Clin Oncol 1999;17:3101-9.

    6) Bonfante V, Santoro A, Viviani S, et al. Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD. J Clin Oncol 1997;15:528-34.

    7) Linch DC, Goldstone AH. High-dose therapy for Hodgkin's disease. Br J Haematol 1999;107:685-90.

    8) Lazarus HM, Rowlings PA, Zhang MJ, et al. Autotransplants for Hodgkin's disease in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 1999;17:534-45.

    9) Josting A, Rueffer U, Franklin J, et al. Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group. Blood 2000;96:1280-6.

    10) Andre M, Henry-Amar M, Pico JL, et al. Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin's disease induction failure: a case-control study. Societe Francaise de Greffe de Moelle. J Clin Oncol 1999;17:222-9.

    11) Czyz J, Hellmann A, Dziadziuszko R, et al. High-dose chemotherapy with autologous stem cell transplantation is an effective treatment of primary refractory Hodgkin's disease. Retrospective study of the Polish Lymphoma Research Group. Bone Marrow Transplant 2002;30:29-34.

    12) Ferme C, Mounier N, Divine M, et al. Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin's disease in relapse or failure after initial chemotherapy: results of the Groupe d'Etudes des Lymphomes de l'Adulte H89 Trial. J Clin Oncol 2002;20:467-75.

    13) Moskowitz CH, Kewalramani T, Nimer SD, et al. Effectiveness of high dose chemoradiotherapy and autologous stem cell transplantation for patients with biopsy-proven primary refractory Hodgkin's disease. Br J Haematol 2004;124:645-52.

    14) Lavoie JC, Connors JM, Phillips GL, et al. High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin Lymphoma: long-term outcome in the first 100 patients treated in Vancouver. Blood 2005;106:1473-8.

    15) Czyz J, Szydlo R, Knopinska-Posluszny W, et al. Treatment for primary refractory Hodgkin's disease: a comparison of high-dose chemotherapy followed by ASCT with conventional therapy. Bone Marrow Transplant 2004;33:1225-9.

    16) Shipp MA, Harrington DP, Klatt MM, et al. Identification of major prognostic subgroups of patients with large-cell lymphoma treated with m-BACOD or M-BACOD. Ann Intern Med 1986;104:757-65.

    17) Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 1993;328:1002-6.

    18) Rodriguez J, Caballero MD, Gutierrez A, et al. Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience. Ann Oncol 2004;15:1504-9.

    19) Guglielmi C, Gomez F, Philip T, et al. Time to relapse has prognostic value in patients with aggressive lymphoma enrolled onto the PARMA trial. J Clin Oncol 1998;16:3264-9.

    20) Stiff PJ, Dahlberg S, Forman SJ, et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin's lymphoma: value of augmented preparative regimens--a Southwest Oncology Group trial. J Clin Oncol 1998;16:48-55.

    21) Mills W, Chopra R, McMillan A, et al. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin's lymphoma. J Clin Oncol 1995;13:588-95.

    22) Prince HM, Crump M, Imrie K, et al. Intensive therapy and autotransplant for patients with an incomplete response to front-line therapy for lymphoma. Ann Oncol 1996;7:1043-9.

    23) Stiff PJ, Dahlberg S, Forman SJ, et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin's lymphoma: value of augmented preparative regimens--a Southwest Oncology Group trial. J Clin Oncol 1998;16:48-55.

    24) Vose JM, Rizzo DJ, Tao-Wu J, et al. Autologous transplantation for diffuse aggressive non-Hodgkin lymphoma in first relapse or second remission. Biol Blood Marrow Transplant 2004;10:116-27.

    25) Vose JM, Zhang MJ, Rowlings PA, et al. Autologous Blood and Marrow Transplant Registry Lymphoma Working Committee. Autologous transplantation for diffuse aggressive non-Hodgkin's lymphoma in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 2001;19:406-13.

    26) Philip T, Armitage JO, Spitzer G, et al. High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin's lymphoma. N Engl J Med 1987;316:1493-8.

    27) Haioun C, Lepage E, Gisselbrecht C, et al. Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma: final analysis of the prospective LNH87-2 protocol--a groupe d'Etude des lymphomes de l'Adulte study. J Clin Oncol 2000;18:3025-30.

    28) Gianni AM, Bregni M, Siena S, et al. High-dose chemotherapy and autologous bone marrow transplantation compared with MACOP-B in aggressive B-cell lymphoma. N Engl J Med 1997;336:1290-7.

    29) Santini G, Salvagno L, Leoni P, et al. VACOP-B versus VACOP-B plus autologous bone marrow transplantation for advanced diffuse non-Hodgkin's lymphoma: results of a prospective randomized trial by the non-Hodgkin's Lymphoma Cooperative Study Group. J Clin Oncol 1998;16:2796-802.

    30) Milpied N, Deconinck E, Gaillard F, et al. Groupe Ouest-Est des Leucemies et des Autres Maladies du Sang. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 2004;350:1287-95.

    31) Martelli M, Vignetti M, Zinzani PL, et al. High-dose chemotherapy followed by autologous bone marrow transplantation versus dexamethasone, cisplatin, and cytarabine in aggressive non-Hodgkin's lymphoma with partial response to front-line chemotherapy: a prospective randomized Italian multicenter study. J Clin Oncol 1996;14:534-42.

    32) Verdonck LF, van Putten WL, Hagenbeek A, et al. Comparison of CHOP chemotherapy with autologous bone marrow transplantation for slowly responding patients with aggressive non-Hodgkin's lymphoma. N Engl J Med 1995;332:1045-51.

    33) Martelli M, Gherlinzoni F, De Renzo A, et al. Early autologous stem-cell transplantation versus conventional chemotherapy as front-line therapy in high-risk, aggressive non-Hodgkin's lymphoma: an Italian multicenter randomized trial. J Clin Oncol 2003;21:1255-62.

    34) Lazarus HM, Loberiza FR Jr, Zhang MJ, et al. Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR). Bone Marrow Transplant 2001;27:387-96.

    35) Schmitz N, Linch DC, Dreger P, et al. Randomised trial of filgrastim-mobilised peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients. Lancet 1996;347:353-7.

  • Top
  • Introduction
  • Methods
  • Results
  • Discussion
  • References
  • [ Top ] [ Summary ] [ PDF ] [ Similar Articles ] [ Mail to Editor ]
    Turkish Journal of Cancer web sitesi Novartis Onkoloji'nin karşılıksız eğitim katkılarıyla hazırlanmıştır.
    [ Main Page | Editorial Board | About | Instructions ]
    [ Table of Contents | Archive | Archive Search | Online Submission | E-mail ]