HIGH-DOSE THERAPY AND AUTOLOGOUS STEM-CELL RESCUE FOR POOR-RISK AND REFRACTORY LYMPHOMA - A SINGLE-CENTER EXPERIENCE OF 123 PATIENTS

Over an 8-year period we autografted 123 patients with poor-risk lymph oma. Sixty-three patients had Hodgkin's disease (HD) and 60 non-Hodgki n's lymphoma (NHL). Of the patients with HD, 45 had responsive and 18 resistant disease prior to high-dose therapy. Fifty-three patients wit h NHL had responsive and seven had resistant disease at the time of tr ansplantation. Seventy-seven patients received autologous bone marrow (BM) rescue, 39 autologous peripheral blood progenitor cell (PBPC) res cue, and seven combined BM and PBPC rescue. High-dose chemotherapy was BEM in 67, BEAM in 39, TBI and cyclophosphamide or etoposide or BCNU in 10, etoposide/mitozantrone in six and etoposide/melphalan in one. T here were eight (6.5%) deaths due to treatment-related toxicity, withi n the first 100 days posttransplantation. Of the patients with HD 41 ( 65%) are alive at a median follow-up of 39 months (range 2-94). Thirty -three (52%) patients remain in CR. The median DFS of the 63 patients with HD is 34 months (95% CI 7-61). The median DFS for patients transp lanted with responsive disease was significantly better than for those transplanted with refractory disease (61 vs 21 months P < 0001). Thir ty-five (58%) of the patients with NHL are alive, and 20 (33%) remain in CR. The median DFS for patients transplanted with responsive and re fractory disease was 11 months (95% CI 3-19) and 4 months (95% CI 0-9; P = NS) respectively. The median DFS for patients transplanted with H D was significantly better than for patients transplanted with NHL (34 vs 8 months, P < 0.002). In both groups there was no significant diff erence in DFS in patients receiving one, two, three or more lines of t herapy prior to transplantation. In summary, in patients with poor-ris k lymphoma who have responsive disease high-dose therapy may result in durable CRs. Conversely, only a small proportion of patients with HD or NHL with resistant disease achieve CR after autologous stem cell re scue.