title: The treatment of relapsed or refractory intermediate grade non-Hodgkin's lymphoma with autologous bone marrow transplantation followed by cyclosporine and interferon.
abstract: In an effort to decrease the relapse rate following autologous bone marrow transplantation for non-Hodgkin's lymphoma, patients were given cyclosporine and interferon following autologous marrow transplantation. Forty patients with intermediate grade non-Hodgkin's lymphoma that was relapsed or refractory to standard chemotherapy underwent autologous marrow transplantation. The preparative regimen consisted of cyclophosphamide 6.8 g/m2, etoposide 1600 mg/m2, and carmustine 400 mg/m2 over 4 days followed by reinfusion of bone marrow. Intravenous cyclosporine was started on day -1 as a 16 mg/kg loading dose followed by 3.6 mg/kg/day for 28 days after transplant. Patients were begun on alpha-interferon (starting dose, 0.5 million units s.c. every other day) following platelet engraftment (median day 24 post-transplant) and continued on 1.5 million units s.c. daily for 2 years. Regimen-related toxicities resulted in four (10%) deaths. Twenty-one (53%) patients developed marked erythema of the palms, soles, and arms. Biopsies of the erythema were consistent with grade I GVHD. Patients who did not develop rashes were not biopsied. The erythema persisted for a median of 10 days and resolved in all cases without treatment. Visceral GVHD was not apparent. All patients have been followed for a median of 24 months (range 12-54 months). To date, only five patients (13%) have relapsed after bone marrow transplant. Multivariant analysis could not identify risk factors for relapse post-transplant. Disease-free survival of all patients is 77% (95% confidence interval, 67-93%). The results of this pilot study suggest that the administration of cyclosporine and interferon may decrease the relapse rate of relapsed/refractory non-Hodgkin's lymphoma following autologous bone marrow transplantation.
authors.affiliation: Department of Medicine, Cooper Hospital/University Medical Center, Camden, NJ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gryn
authors.forename: E
authors.initials: E
authors.lastname: Johnson
authors.forename: N
authors.initials: N
authors.lastname: Goldman
authors.forename: L
authors.initials: L
authors.lastname: Devereux
authors.forename: G
authors.initials: G
authors.lastname: Grana
authors.forename: A
authors.initials: A
authors.lastname: Hageboutros
authors.forename: E
authors.initials: E
authors.lastname: Fernandez
authors.forename: C
authors.initials: C
authors.lastname: Constantinou
authors.forename: W
authors.initials: W
authors.lastname: Harrer
authors.forename: E
authors.initials: E
authors.lastname: Viner
authors.forename: J
authors.initials: J
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D016898:Interferon-alpha / Q000008:administration & dosage*; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014182:Transplantation, Autologous
chemical_list: D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D016572:Cyclosporine