title: Cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non-Hodgkin's lymphoma: a dose-finding study.
abstract: Cyclophosphamide, carmustine (BCNU), and etoposide (VP-16) (CBV) is a widely used conditioning regimen in autologous bone marrow transplantation (ABMT) of patients with refractory and relapsed lymphoma. However, the maximum-tolerated dose (MTD) of these agents when used in combination has not been systematically explored. We treated 58 patients (28 with non-Hodgkin's lymphoma [NHL], 30 with Hodgkin's disease [HD]) at seven dose levels of CBV. Doses were cyclophosphamide 4,500 to 7,200 mg/m2, BCNU 450 to 600 g/m2, and VP-16 1,200 to 2,000 mg/m2. The MTD was cyclophosphamide 7,200 mg/m2, BCNU 450 mg/m2, and VP-16 2,000 mg/m2. Six hundred milligrams per square meter of BCNU was associated with five of 18 cases of interstitial pneumonitis versus two of 40 at 450 mg/m2 (P = .02). Treatment-related mortality was 5% at dose levels less than or equal to the MTD and 22% at the highest dose. In this heavily pretreated patient population, most of whom had high volume residual disease, complete responses (CRs) to CBV and ABMT occurred in 25% of assessable patients with NHL and 43% of patients with HD. Thirteen of 28 patients with NHL and 14 of 30 with HD remain free from disease progression with median follow-up of 212 and 215 days, respectively. CBV can be administered with acceptable toxicity over a wide range of doses to patients with refractory and relapsed lymphoma.
authors.affiliation: Thorndike Memorial Laboratories, Dana Research Institute, Boston, MA.
authors.forename: C
authors.initials: C
authors.lastname: Wheeler
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
authors.forename: W H
authors.initials: WH
authors.lastname: Churchill
authors.forename: S E
authors.initials: SE
authors.lastname: Come
authors.forename: B R
authors.initials: BR
authors.lastname: Smith
authors.forename: G J
authors.initials: GJ
authors.lastname: Bubley
authors.forename: D S
authors.initials: DS
authors.lastname: Rosenthal
authors.forename: J M
authors.initials: JM
authors.lastname: Rappaport
authors.forename: K A
authors.initials: KA
authors.lastname: Ault
authors.forename: L E
authors.initials: LE
authors.lastname: Schnipper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine