Autologous bone marrow transplantation in adults with non-Hodgkin's lymphoma: a Southwest Oncology Group study.
Patients with non-Hodgkin's lymphoma (NHL) who fail conventional chemotherapy have a dismal outcome. Reports from single institutions utilizing high-dose chemoradiotherapy plus Autologous Bone Marrow Transplantation (ABMT) in this setting suggest three-year disease-free survival between 15-60 per cent. From 1985 to 1989 the Southwest Oncology Group performed a prospective multi-institutional study involving ABMT in relapsed/refractory NHL. Forty-five patients, ages 6-60 (median 38), with relapsed NHL were treated with high-dose cyclophosphamide (60 mg/kg/d x 2), total body irradiation (200 cGy/d x 6), and autologous unpurged bone marrow. Histologic subtypes included high grade lymphoma (10), intermediate grade lymphoma (33), and low grade lymphoma (2). Disease status pre-ABMT was sensitive relapse (16), resistant relapse (13), and untreated relapse (16). The actuarial three-year event-free survival and overall survival for all patients were 27 per cent and 38 per cent respectively. Causes of failure included regimen-related deaths (4), lack of response (10), or tumour progression (20) which occurred at a median of 5 months (1-22) post-ABMT and usually at previous sites of involvement. Response to salvage therapy pre-ABMT, a reflection of a tumour's biological behaviour, was the most important predictor of good outcome post-ABMT. This study confirms that a significant number of patients with recurrent NHL can achieve prolonged disease-free survival after ABMT.
Saez
R
R
Section of Hematology/Oncology, University of Oklahoma Health Science Center, Oklahoma City 73190.
Dahlberg
S
S
Appelbaum
F R
FR
Hartsock
R J
RJ
Lemaistre
F
F
Coltman
C A
CA
Fisher
R I
RI
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016026:Bone Marrow Transplantation / Q000276:immunology; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D003520:Cyclophosphamide