AUTOLOGOUS BONE-MARROW TRANSPLANTATION AS COMPARED WITH SALVAGE CHEMOTHERAPY IN RELAPSES OF CHEMOTHERAPY-SENSITIVE NON-HODGKINS-LYMPHOMA

Background. High-dose chemotherapy followed by autologous bone marrow transplantation is a therapeutic option for patients with chemotherapy -sensitive non-Hodgkin's lymphoma who have relapses. In this report we describe a prospective randomized study of such treatment. Methods. A total of 215 patients with relapses of non-Hodgkin's lymphoma were tr eated between July 1987 and June 1994. All patients received two cours es of conventional chemotherapy. The 109 patients who had a response t o chemotherapy were randomly assigned to receive four courses of chemo therapy plus radiotherapy (54 patients) or radiotherapy plus intensive chemotherapy and autologous bone marrow transplantation (55 patients) . Results. The overall rate of response to conventional chemotherapy w as 58 percent; among patients with relapses after chemotherapy, the re sponse rate was 64 percent, and among those with relapses during chemo therapy, the response rate was 21 percent. There were three deaths fro m toxic effects among the patients in the transplantation group, and n one among those in the group receiving chemotherapy without transplant ation. The two groups did not differ in terms of prognostic factors. T he median follow-up time was 63 months. The response rate was 84 perce nt after bone marrow transplantation and 44 percent after chemotherapy without transplantation. At five years, the rate of event-free surviv al was 46 percent in the transplantation group and 12 percent in the g roup receiving chemotherapy without transplantation (P = 0.001), and t he rate of overall survival was 53 and 32 percent, respectively (P = 0 .038). Conclusions. As compared with conventional chemotherapy, treatm ent with high-dose chemotherapy and autologous bone marrow transplanta tion increases event-free and overall survival in patients with chemot herapy-sensitive non-Hodgkin's lymphoma in relapse.