title: Outcome of Patients with Relapsed or Refractory Non-Hodgkin's Lymphoma Referred for Autologous Bone Marrow Transplantation.
abstract: Fifty-one patients with relapsed or refractory intermediate- or high-grade non-Hodgkin's lymphoma were referred for autologous bone marrow transplantation (ABMT). The primary criterion for eligibility was sensitivity to conventional-dose salvage chemotherapy. Of 47 patients who received salvage chemotherapy, 30 demonstrated chemotherapy-sensitive disease. Six eligible patients did not undergo ABMT for various reasons. A total of 24 patients underwent ABMT, with etoposide, melphalan ± total body irradiation as the intensive therapy regimen. There was one early treatment-related death and three non-responders. Of the remaining patients, 9 relapsed, while 11 remain in continuous complete remission (CR) at a median follow-up of 21 months after transplant (range 5-37 months). Two patients with chemosensitive disease and bone marrow involvement underwent allogeneic BMT with marrow from HLA-identical siblings. Both are in continuous CR at 6 and 12 months follow-up. Of the 25 patients who did not undergo ABMT, all have died (median survival 5 months). The results indicate that approximately one-half of relapsed or refractory aggressive histology lymphoma patients referred for ABMT eventually undergo transplantation, if chemotherapy-sensitive relapse is the major criterion for eligibility. Approximately 25% of the referred patients may become long-term disease-free survivors with this approach. Reports of marrow transplant series should include all patients referred for ABMT as the denominator for calculating disease-free survival in order to reduce the bias of patient selection.
authors.affiliation: a University of Toronto Autologous Bone Marrow Transplant Program, Toronto Hospital, Toronto, Ontario.
authors.forename: J M
authors.initials: JM
authors.lastname: Brandwein
authors.affiliation: b London Regional Cancer Centre, London, Ontario.
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: c Victoria General Hospital, Halifax, Nova Scotia.
authors.forename: G R
authors.initials: GR
authors.lastname: Langley
authors.affiliation: d Saint John Regional Hospital, Saint John, New Brunswick, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Burnell
authors.affiliation: a University of Toronto Autologous Bone Marrow Transplant Program, Toronto Hospital, Toronto, Ontario.
authors.forename: S B
authors.initials: SB
authors.lastname: Sutcliffe
authors.affiliation: a University of Toronto Autologous Bone Marrow Transplant Program, Toronto Hospital, Toronto, Ontario.
authors.forename: A
authors.initials: A
authors.lastname: Keating
keywords: Non-Hodgkin's lymphoma; autologous marrow transplant; salvage chemotherapy