Limited efficacy of intensified preparative regimens and autologous transplantation as salvage therapy in high grade non-Hodgkin's lymphoma.
Between 9/86 and 6/98, 22 patients with relapsed or refractory high grade lymphoma received intensified preparative therapy and underwent autologous transplantation at a single institution. Two intensified preparative regimens were used--cyclophosphamide, etoposide, total body irradiation (CY-VP-TBI) (N=17) and cyclophosphamide, BCNU, etoposide (CBV) (N=5). For all patients undergoing autologous transplantation, 5 year actuarial survival (S) and 5 year event free survival (EFS) were only 18% +/- 8%. Treatment related mortality was 14% overall but only 8% in patients receiving G-CSF or GM-CSF. Survival was significantly inferior to the survival observed in a concurrent series of patients with intermediate grade lymphoma, 34% +/- 6%, p < .05. Using high dose therapy in conjunction with autologous transplantation at the time of relapse may not be as valuable a strategy in high-grade lymphoma as in intermediate grade lymphoma although most studies combine the two disorders. Alternative strategies for the use of transplantation in high grade lymphoma, such as the use of transplantation as consolidation therapy, need to be investigated.
Stein
R S
RS
Department of Medicine, Vanderbilt University School of Medicine, and VA Medical Center, Nashville, TN 37232, USA. steinrs@ctrvax.vanderbilt.edu
Greer
J P
JP
Goodman
S
S
Brandt
S J
SJ
Morgan
D S
DS
Macon
W R
WR
McCurley
T L
TL
Wolff
S N
SN
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation