Thoracic stop-flow perfusion for refractory lymphoma: a phase I-II evaluation trial.
BACKGROUND
Management of patients with heavily pretreated malignant lymphoma failing front-line treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue is problematic. A phase I-II evaluation trial was conducted to evaluate thoracic stop-flow perfusion.


METHODS
nine refractory patients were enrolled in the study. The schedule of thoracic stop-flow perfusion was based on cisplatin (100 mg/m(2)) and melphalan (25 mg/m(2)). Melphalan pharmacokinetic analyses were performed. All patients received hemofiltration during each procedure.


RESULTS
Overall 18 cycles of perfusional chemotherapy were administered. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. Hematological and non-hematological toxicity was mild in relation to the use of hemofiltration during the procedures. All 9 patients responded favourably to stop-flow therapy. We observed 5 CR and 4 PR. Four out of five patients in CR relapsed. Three out of these four died of progressive disease after a response duration of 9, 7 and 7 months, respectively. One patient had a duration of CR of 10 months before relapse. He attained a new PR (+ 3 months). The remaining complete responder is still in remission after 37+ months. The 4 patients in PR progressed and died after a response duration of 4, 6, 2 and 1 month, respectively. To date, 8 out of 9 patients have died and one is still alive.


CONCLUSIONS
Thoracic stop-flow perfusion seems very active in this kind of patient.
Ruscitti
Cristina
C
Department of Surgical Sciences, University of L'Aquila, Italy.
Guadagni
Stefano
S
Russo
Filippo
F
Palumbo
Giancarlo
G
Fiorentini
Giammaria
G
Mambrini
Andrea
A
Cantore
Maurizio
M
Kanavos
Evangelos
E
Pinto
Antonio
A
Amicucci
Gianfranco
G
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D013909:Thorax
D000970:Antineoplastic Agents