title: High-dose fractionated total-body irradiation, etoposide and cyclophosphamide for treatment of malignant lymphoma: comparison of autologous bone marrow and peripheral blood stem cells.
abstract: Consecutive patients with non-Hodgkin's lymphoma (NHL, n = 133) or Hodgkin's disease (HD, n = 20) were treated with 12.0 Gy of fractionated total body irradiation, etoposide 60 mg/kg, and CY 100 mg/kg followed by infusion of autologous hematopoietic stem cells. Seventy-nine patients received purged (n = 62) or unpurged BM (n = 17), and 74 received unpurged PBSCs alone (n = 56) or with BM (n = 18). The median day for achieving a sustained granulocyte count of 0.5 x 10(9)/I was 14 range (7-66) for BM recipients and 10 (7-30) for PBSC +/- BM recipients (P = 0.03). A platelet count of 20 x 10(9)/I was achieved at a median of day 24 (6-145) in BM recipients and day 11 (range, 7-56) in PBSC +/- BM recipients (P = 0.007). The median number of platelet units transfused was 86 (0-1432) for BM recipients and 30 (6-786) for PBSC +/- BM recipients (P = 0.001). The median number of hospital days was 36 (10-88) for BM recipients and 27 (14-76) for PBSC +/- BM recipients (P = 0.0001). The unadjusted Kaplan-Meier (KM) estimates of survival, event-free survival (EFS) and relapse at 2 years were 0.57, 0.45 and 0.43 for patients receiving BM and 0.55, 0.36 and 0.59 for patients receiving PBSC +/- BM. After adjusting for confounding variables, the estimated relative risk (RR) of death from any cause was 0.92 (P = 0.75), of relapse was 1.25 (P = 0.39), of non-relapse mortality was 0.71 (P = 0.42) and of mortality and/or relapse was 1.17 (P = 0.48) for patients receiving PBSC +/- BM as compared to BM. For 46 patients with NHL receiving unpurged PBSC alone, the unadjusted KM estimate of relapse was 0.61 compared with 0.48 for 52 comparable patients receiving purged BM, while the RR for relapse for patients receiving unpurged PBSCs was 1.37 (P = 0.33) after adjusting for other significant covariates. These data confirm previous observations that patients who receive PBSC +/- BM have faster engraftment, fewer transfusions and shorter hospital stays than patients who receive only BM. There were no statistically significant differences between the two groups in survival, relapse, death from causes other than relapse and event-free survival.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Brunvand
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: E
authors.initials: E
authors.lastname: Soll
authors.forename: C H
authors.initials: CH
authors.lastname: Weaver
authors.forename: S D
authors.initials: SD
authors.lastname: Rowley
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: K
authors.initials: K
authors.lastname: Lilleby
authors.forename: R A
authors.initials: RA
authors.lastname: Clift
authors.forename: T A
authors.initials: TA
authors.lastname: Gooley
authors.forename: O W
authors.initials: OW
authors.lastname: Press
authors.forename: A
authors.initials: A
authors.lastname: Fefer
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: J E
authors.initials: JE
authors.lastname: Sanders
authors.forename: P L
authors.initials: PL
authors.lastname: Martin
authors.forename: T
authors.initials: T
authors.lastname: Chauncey
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: N
authors.initials: N
authors.lastname: Zuckerman
authors.forename: P
authors.initials: P
authors.lastname: Montgomery
authors.forename: R
authors.initials: R
authors.lastname: Dorn
authors.forename: P L
authors.initials: PL
authors.lastname: Weiden
authors.forename: T
authors.initials: T
authors.lastname: Demirer
authors.forename: L A
authors.initials: LA
authors.lastname: Holmberg
authors.forename: K
authors.initials: K
authors.lastname: Schiffman
authors.forename: P A
authors.initials: PA
authors.lastname: McSweeney
authors.forename: C D
authors.initials: CD
authors.lastname: Buckner
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D016298:Hematopoietic Cell Growth Factors / Q000494:pharmacology / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015993:Life Tables; D008223:Lymphoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000401:mortality; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D016298:Hematopoietic Cell Growth Factors; D005047:Etoposide; D003520:Cyclophosphamide