USE OF HIGH-DOSE CHEMOTHERAPY PLUS GRANULOCYTE-COLONY-STIMULATING FACTOR FOR THE SALVAGE OF REFRACTORY OR RESISTANT-RELAPSE LYMPHOMA PATIENTS WITHOUT STEM-CELL SUPPORT

The combination of cyclophosphamide (CY) and etoposide is synergistic, spares bone marrow stem cells and can be given repeatedly in high dos es without stem cell support. Thirteen patients-with non-Hodgkin's lym phoma (n = 8) or Hodgkin's disease (n = 5), received high-dose chemoth erapy (HDC). Median age was 32 years (24-52). Male to female ratio was 10:3. All the patients were in advanced stage. Karnofsky score prior to HDC was 60% (range 40-90). Six patients showed primary refractorine ss and 7 had resistant relapse. HDC consisted of CY 1,500 mg/m(2)/day and etoposide 300 mg/m(2)/day, both for 4 days. rhG-CSF was started 24 h after the last dose of chemotherapy as a continuous intravenous inf usion at a dose of 0.01 mg/kg/day and stopped when the leukocyte count reached 1 x 10(9)/l on 3 consecutive days. Overall, 69% (9/13) of pat ients-responded to HDC. Four achieved CR and 5 achieved PR. Two of the patients showed disease progression. The other 2 died during the earl y period of HDC. Neutrophil and platelet recovery after HDC were 8 (6- 16) and 10 (4-14) days, respectively; The major nonhematological toxic ities were nausea-vomiting (100%) and diarrhea (61%). The median follo w-up was 204 (7-600) days. Two patients relapsed 48 and 185 days after HDC. Eight patients are still alive, 7 progression free. The progress ion-free survival is 220 (40-285) days. In conclusion, HDC+granulocyte colony- stimulating factor (G-CSF), without stem cell support seems t o be promising in refractory or resistant relapse lymphoma patients br inging the need for randomized studies to show the-cost effectiveness of HDC+G-CSF compared to HDC+ autologous stem cell support.