title: Treatment of patients with relapsed and resistant non-Hodgkin's lymphoma using total body irradiation, etoposide, and cyclophosphamide and autologous bone marrow transplantation.
abstract: OBJECTIVE
  Patients with non-Hodgkin's lymphoma (NHL) who do not achieve a complete response (CR) after induction chemotherapy or who relapse after achieving a CR are rarely cured of their disease by the usual salvage therapy. Success of high-dose cytotoxic therapy with an autologous bone marrow transplant (AuBMT) is limited. We describe the results of a prospective single-institution study using a new conditioning regimen for patients with relapsed or resistant NHL who underwent AuBMT.
  
  
  METHODS
  Forty-four patients were reinduced with cytotoxic therapy and then evaluated for response. All patients received the conditioning regimen of hyperfractionated total body irradiation (TBI), etoposide (VP-16), and cyclophosphamide (CTX) followed by autologous bone marrow reinfusion.
  
  
  RESULTS
  The disease-free survival (DFS) rate was 57% with a median follow-up of 42+ months. The only variable significantly associated with DFS was the patient's remission status at AuBMT. Patients who underwent AuBMT in CR had a DFS of 80%, whereas patients who underwent AuBMT in partial response (PR) or with progressive disease (PD) had a DFS of 60% and 11%, respectively (P = .002). The major toxicity was hemorrhage at the site of bulky disease, especially in patients with residual mediastinal and/or pulmonary disease.
  
  
  CONCLUSIONS
  Planned reinduction cytotoxic therapy followed by TBI, VP-16, and CTX with AuBMT is an effective treatment for patients with relapsed and resistant NHL.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
authors.forename: S
authors.initials: S
authors.lastname: Gulati
authors.forename: J
authors.initials: J
authors.lastname: Yahalom
authors.forename: L
authors.initials: L
authors.lastname: Acaba
authors.forename: L
authors.initials: L
authors.lastname: Reich
authors.forename: R
authors.initials: R
authors.lastname: Motzer
authors.forename: J
authors.initials: J
authors.lastname: Crown
authors.forename: M
authors.initials: M
authors.lastname: Toia
authors.forename: T
authors.initials: T
authors.lastname: Igarashi
authors.forename: R
authors.initials: R
authors.lastname: Lemoli
authors.forename: E
authors.initials: E
authors.lastname: Hanninen
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide