title: Autologous tandem transplantation in patients with primary progressive or relapsed/refractory lymphoma.
abstract: Patients with primary progressive or refractory Hodgkin's disease (HD) or aggressive non-Hodgkin's lymphoma (NHL) have a particularly poor prognosis. Here we report the results of autologous tandem transplantation in these patients. Patients aged 18-55 years with primary progressive or refractory relapsed HD and aggressive NHL were included. Patients received high-dose etoposide (2000 mg/m(2)) followed by peripheral blood stem cell harvest (PBSC). The first high-dose chemotherapy (TMC) consisted of thiotepa (750 mg/m(2)), mitoxantrone (40 mg/m(2)), and carboplatin (990 mg/m(2)). Patients with no change (NC), partial remission (PR), or complete remission (CR) after TMC then received BEAM with carmustine (300 mg/m(2)), etoposide (1200 mg/m(2)), cytarabine (1600 mg/m(2)), and melphalan (140 mg/m(2)). Patients with bulky disease (>5 cm) or residual lymphoma received involved field radiotherapy. Twenty-five patients were included (HD=10, NHL=15, median age 34 years). Two patients with HD achieved a CR and five patients a PR [response rate (RR) 70%]. Three patients (30%) experienced treatment failure including two deaths due to peritransplant complications. Five patients with aggressive NHL were in CR and two patients in PR (RR 46%). Of the eight patients (56%) with treatment failure, three had progressive disease and five died from peritransplant complications. Freedom from treatment failure (FFTF) and overall survival (OS) for all patients after 12 months was 28% and 40%, respectively. Tandem HDCT followed by autologous stem cell transplantation (ASCT) offers a chance of cure in these poor prognostic patients, but is associated with risks.
authors.affiliation: First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Glossmann
authors.forename: Jan Oliver
authors.initials: JO
authors.lastname: Staak
authors.forename: Lucia
authors.initials: L
authors.lastname: Nogova
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.forename: Christoph
authors.initials: C
authors.lastname: Scheid
authors.forename: Jens
authors.initials: J
authors.lastname: Kisro
authors.forename: Hans-Edgar
authors.initials: HE
authors.lastname: Reis
authors.forename: Norma
authors.initials: N
authors.lastname: Peter
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Andreas
authors.initials: A
authors.lastname: Josting
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011336:Probability; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D017211:Treatment Failure