PRIMARY SYSTEMIC CD30 (KI-1)-POSITIVE ANAPLASTIC LARGE-CELL LYMPHOMA OF THE ADULT - SEQUENTIAL INTENSIVE TREATMENT WITH THE F-MACHOP REGIMEN (+ -RADIOTHERAPY) AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION/

Few series of adult patients with primary systemic CD30 (Ki-1)-positiv e anaplastic large cell lymphoma (ALCL) are reported in the literature ; most of them have been treated with combination chemotherapy (CHT), with only an occasional patient being autotransplanted, mainly after r elapsing. The remission rate ranges from 60% to 90%, but relapses are frequent (up to 60%) and precocious (mainly in the first 24 months). T he aim of our study was to analyze the outcome of a series of adult pa tients affected by primary systemic ALCL that were treated at our inst itution with a sequential intensive therapeutic program including CHT, radiotherapy (RT), and autologous bone marrow transplantation (ABMT). Sixteen consecutive, unselected patients with ALCL were identified. A ll of them were treated with the 5-fluorouracil, methotrexate. cytosin e arabinoside, cyclophosphamide, doxorubicin. vincristine, and prednis one (F-MACHOP) regimen; 9 of 16 (56.2%) reached a complete remission ( CR). In six cases with residual mediastinal disease, involved-field RT was performed, allowing three additional patients to become free of d isease. All 16 were then autotransplanted with bone marrow stem cells after conditioning with the cytosine arabinoside, etoposide, cyclophas phamide, and carmustine (BAVC) regimen. At present, 16 of 16 patients are alive and in CR. The actuarial overall survival is 100% at a media n of 45.5 months, and the actuarial disease-free survival is 100% at a median of 33.5 months. These data suggest that ALCL can be successful ly managed with a sequential intensive treatment (CHT +/- RT +/- ABMT) that prevents early relapses and projects these patients as long-term survivors. (C) 1996 by The American Society of Hematology.