PERIPHERAL-BLOOD PROGENITOR-CELL MOBILIZATION WITH DEXA-BEAM G-CSF, ETHER LIPID PURGING, AND AUTOLOGOUS TRANSPLANTATION AFTER HIGH-DOSE CBVTREATMENT - A SAFE AND EFFECTIVE REGIMEN IN PATIENTS WITH POOR-RISK MALIGNANT-LYMPHOMAS/

High-dose chemotherapy followed by autologous peripheral blood progeni tor cell transplantation (PBPCT) is increasingly applied in patients w ith relapsed, poor risk malignant lymphomas. Different strategies for progenitor cell mobilization using cytoreductive chemotherapy, hematop oietic growth factors, or both have been described. We studied the saf ety and efficacy of a modified DexaBEAM regimen (dexamethasone, BCNU [ carmustine], etoposide, ara-C, melphalan) Followed by granulocyte-colo ny stimulating factor (G-CSF) that was administered in order to minimi ze any residual disease and to obtain a sufficient amount of progenito r cells in the autografts. Until now, 16 patients at poor risk (8 with Hodgkin's disease, 8 with non-Hodgkin's lymphoma) entered the study. All the 12 patients with measurable disease at study entry responded t o DexaBEAM. Median time of subsequent leukopenia (leukocytes <1.000/mu L) was 6 days (range 5-8 days). Peak numbers of CD34+ hematopoietic p rogenitor cells appeared in the peripheral blood after a median of 20 days (range 18-22 days) after onset of therapy. At that time, peripher al mononuclear cells were collected for autografting. Thereafter, the leukapheresis products were frozen until the day of transplantation, e ither unpurged in the case of Hodgkin's disease or purged with the eth er lipid edelfosine in cases of non-Hodgkin's lymphoma. After high-dos e chemotherapy with the CBV regimen (cyclophosphamide, BCNU, etoposide ) the patients received their autografts, followed again by G-CSF trea t ment. A stable hematopoietic recovery was reached with granulocytes >2.000/mu L within 11 days (range 8-17 days), and platelets >50.000/mu L within 15 days (range 10-31 days), respectively, without significan t differences between the purged and unpurged transplants. After a med ian follow-up of 28 months (range 1-40 months) 7 patients are alive wi thout signs of recurrent disease, while 1 patient has died due to acut e treatment related toxicity. Three patients had refractory disease, a nd 5 have relapsed of whom 4 have died. In summary, the DexaBEAM/G-CSF /CBV strategy appears to be safe and effective for salvage treatment i n patients with poor risk malignant lymphomas.