HIGH-DOSE FRACTIONATED TOTAL-BODY IRRADIATION, ETOPOSIDE AND CYCLOPHOSPHAMIDE FOR TREATMENT OF MALIGNANT-LYMPHOMA - COMPARISON OF AUTOLOGOUS BONE-MARROW AND PERIPHERAL-BLOOD STEM-CELLS

Consecutive patients with non-Hodgkin's lymphoma (NHL, n = 133) or Hod gkin's disease (HD, n = 20) were treated with 12.0 Gy of fractionated total body irradiation, etoposide 60 mg/kg, and CY 100 mg/kg followed by infusion of autologous hematopoietic stem cells. Seventy-nine patie nts received purged (n = 62) or unpurged BM (n = 17), and 74 received unpurged PBSCs alone (n = 56) or with BM (n = 18). The median day for achieving a sustained granulocyte count of 0.5 x 10(9)/I was 14 range (7-66) for BM recipients and 10 (7-30) for PBSC +/- BM recipients (P = 0.03). A platelet count of 20 x 10(9)/I was achieved at a median of d ay 24 (6-145) in BM recipients and day 11 (range, 7-56) in PBSC +/- BM recipients (P = 0.007). The median number of platelet units transfuse d was 86 (0-1432) for BM recipients and 30 (6-786) for PBSC +/- BM rec ipients (P = 0.001). The median number of hospital days was 36 (10-88) for BM recipients and 27 (14-76) for PBSC +/- BM recipients (P = 0.00 01). The unadjusted Kaplan-Meier (KM) estimates of survival, event-fre e survival (EFS) and relapse at 2 years were 0.57, 0.45 and 0.43 for p atients receiving BM and 0.55, 0.36 and 0.59 for patients receiving PB SC +/- BM. After adjusting for confounding variables, the estimated re lative risk (RR) of death from any cause was 0.92 (P = 0.75), of relap se was 1.25 (P = 0.39), of non-relapse mortality was 0.71 (P = 0.42) a nd of mortality and/or relapse was 1.17 (P = 0.48) for patients receiv ing PBSC +/- as compared to BM. For 46 patients with NHL receiving unp urged PBSC alone, the unadjusted KM estimate of relapse was 0.61 compa red with 0.48 for 52 comparable patients receiving purged BM, while th e RR for relapse for patients receiving unpurged PBSCs was 1.37 (P = 0 .33) after adjusting for other significant covariates. These data conf irm previous observations that patients who receive PBSC +/- BM have f aster engraftment, fewer transfusions and shorter hospital stays than patients who receive only BM. There were no statistically significant differences between the two groups in survival, relapse, death from ca uses other than relapse and event-free survival.