HEMATOLOGIC RECOVERY AND SURVIVAL OF LYMPHOMA PATIENTS AFTER AUTOLOGOUS STEM-CELL TRANSPLANTATION - COMPARISON OF BONE-MARROW AND PERIPHERAL-BLOOD PROGENITOR CELLS

Autologous stem-cell transplantation is widely used as part of the tre atment of poor prognosis lymphoma patients. Since 1986, peripheral blo od progenitor cells (PBPC) mobilized by chemotherapy and/or hematopoie tic growth factors have progressively been used instead of autologus b one marrow (BM) cells. Toxicity, engraftment and long-term outcome wer e compared in a population oi relapsing or refractory lymphoma patient s given high-dose therapy. During 1986 to 1993, 150 patients with refr actory or relapsed non-Hodgkin's lymphomas (n = 93) or Hodgkin's disea se (n = 57) received intensive therapy followed by the reinjection of BM (r = 72) or PBPC (n = 78). PBPC were collected by aphereses during the phase of hematologic recovery after mobilization by chemotherapy a lone (n = 36) or associated with GCSF (n = 43). Conditioning regimens included chemotherapy alone in 77%, associated with total body irradia tion (TBI) in 23%. After stem-cell reinfusion, 55% of the PBPC group r eceived GCSF versus 24% in the BM group. Results show that the median time to neutrophil counts >500/mu l and platelets >50,000/mu l was sig nificantly shorter in the PBPC than the BM group, respectively 13 vers us 23 days and 18 versus 26 days (P < 0.05). This difference remained significant (P < 0.05) when patients were stratified according to the administration or not of GCSF after transplantation. PBPC grafting aft er high-dose therapy was associated with a median reduction of the hos pital stay of 10 days. The majority of patients (90%) maintained norma l blood counts at 3 months, and no secondary graft failure was observe d in either group. The use of TBI in the conditioning regimen was the only significant factor affecting long-term hematologic recovery. For relapsing patients with histologically aggressive lymphomas, overall s urvival and failure-free survival were similar in both groups. In conc lusion, PBPC transplantation is a safe procedure associated with impro vement of hematopoietic recovery and a shortened hospital stay.