title: High-dose fractionated total-body irradiation, etoposide, and cyclophosphamide followed by autologous stem-cell support in patients with malignant lymphoma.
abstract: OBJECTIVE
  To evaluate a high-dose treatment regimen of fractionated total-body irradiation (TBI), etoposide, and cyclophosphamide (Cy) followed by autologous stem-cell transplantation (ASCT) in patients with malignant lymphoma.
  
  
  METHODS
  Fifty-three patients with non-Hodgkin's lymphoma (NHL; n = 43) or Hodgkin's disease (HD; n = 10) received 12.0 Gy of fractionated TBI, etoposide 60 mg/kg, and Cy 100 mg/kg followed by infusion of autologous hematopoietic stem cells.
  
  
  RESULTS
  Thirty-one of 53 patients are alive a median of 643 (range, 177 to 1,144) days after transplant. The 2 year Kaplan-Meier (K-M) estimates of survival, event-free survival (EFS), and relapse for all 53 patients were 54%, 45%, and 43%, respectively. Sixteen of 24 patients with less advanced disease and 10 of 29 patients with more advanced disease survive free of disease for K-M estimates of EFS of 61% and 31%, respectively (P = .006). The K-M estimates of relapse were 34% for patients with less advanced disease and 53% (P = .05) for patients with more advanced disease. The K-M estimates of dying from causes other than relapse were 8% in patients with less versus 25% in patients with more advanced disease (P = .09).
  
  
  CONCLUSIONS
  These data indicate that approximately 60% of patients transplanted early after failure of initial therapy for malignant lymphoma are projected to be disease-free more than 2 years after treatment with fractionated TBI, etoposide, and Cy and infusion of autologous hematopoietic stem cells. The transplant-related mortality rate is low and relapse is the main cause of treatment failure in patients with less advanced disease. For patients with more advanced disease, the K-M estimates of both transplant-related deaths (25%) and relapse (53%) remain major problems.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: C H
authors.initials: CH
authors.lastname: Weaver
authors.forename: F B
authors.initials: FB
authors.lastname: Petersen
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: O
authors.initials: O
authors.lastname: Press
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.forename: B
authors.initials: B
authors.lastname: Sandmaier
authors.forename: H J
authors.initials: HJ
authors.lastname: Deeg
authors.forename: J A
authors.initials: JA
authors.lastname: Hansen
authors.forename: M
authors.initials: M
authors.lastname: Brunvand
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide