title: Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas.
abstract: OBJECTIVE
  To evaluate the use of high-dose sequential chemotherapy in a Brazilian population.
  
  
  METHODS
  High-dose cyclophosphamide followed by autologous hematopoietic stem cell transplantation is an effective and feasible therapy for refractory/relapsed lymphomas; this regimen has never before been evaluated in a Brazilian population. All patients (106 with high-grade non-Hodgkin lymphoma and 77 with Hodgkin's lymphoma) submitted to this treatment between 1998 and 2006 were analyzed. Chemotherapy consisted of the sequential administration of high-dose cyclophosphamide (4 or 7 g/m(2)) and granulocyte-colony stimulating factor (300 µg/day), followed by peripheral blood progenitor cell harvesting, administration of etoposide (2g/m(2)) and methotrexate (8 g/m(2) only for Hodgkin's lymphoma) and autologous hematopoietic stem cell transplantation.
  
  
  RESULTS
  At diagnosis, non-Hodgkin lymphoma patients had a median age of 45 (range: 8-65) years old, 78% had diffuse large B-cell lymphoma and 83% had stage III/IV disease. The Hodgkin's lymphoma patients had a median age of 23 (range: 7-68) years old, 64.9% had the nodular sclerosis subtype and 65% had stage III/IV disease. Nine Hodgkin's lymphoma patients (13%) and 10 (9%) non-Hodgkin lymphoma patients had some kind of cardiac toxicity. The overall survival, disease-free survival and progression-free survival in Hodgkin's lymphoma were 29%, 59% and 26%, respectively. In non-Hodgkin lymphoma, these values were 40%, 49% and 31%, respectively. High-dose cyclophosphamide-related mortality was 10% for Hodgkin's lymphoma and 5% for non-Hodgkin lymphoma patients. High-dose cyclophosphamide dosing had no impact on toxicity or survival for both groups.
  
  
  CONCLUSIONS
  Despite a greater prevalence of poor prognostic factors, our results are comparable to the literature. The incidence of secondary neoplasias is noteworthy. Our study suggests that this approach is efficient and feasible, regardless of toxicity-related mortality.
authors.affiliation: Hematology and Hemotherapy Center, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brazil.
authors.forename: Bruno Kosa Lino
authors.initials: BK
authors.lastname: Duarte
authors.forename: Eliana Cristina Martins
authors.initials: EC
authors.lastname: Miranda
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Afonso Celso
authors.initials: AC
authors.lastname: Vigorito
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Penteado
authors.forename: José Francisco Comenalli
authors.initials: JF
authors.lastname: Marques
authors.forename: Gislaine Borba
authors.initials: GB
authors.lastname: Oliveira-Duarte
authors.forename: Irene Gyongyver Heidemarie
authors.initials: IG
authors.lastname: Lorand-Metze
authors.forename: Katia Borgia
authors.initials: KB
authors.lastname: Pagnano
authors.forename: Marcia Torresan
authors.initials: MT
authors.lastname: Delamain
authors.forename: Renata
authors.initials: R
authors.lastname: Baldissera
authors.forename: Isabella Salvetti
authors.initials: IS
authors.lastname: Valente
authors.forename: Carmino Antonio
authors.initials: CA
authors.lastname: de Souza