HIGH-DOSE FRACTIONATED TOTAL-BODY IRRADIATION, ETOPOSIDE, AND CYCLOPHOSPHAMIDE FOLLOWED BY AUTOLOGOUS STEM-CELL SUPPORT IN PATIENTS WITH MALIGNANT-LYMPHOMA

Purpose: To evaluate ct high-dose treatment regimen of fractionated to tal-body irradiation (TBI), etoposide, and cyclophosphamide (Cy) follo wed by autologous stem-cell transplantation (ASCT) in patients with ma lignant lymphoma. Patients and Methods: Fifty-three patients with non- Hodgkin's lymphoma (NHL; n = 43) or Hodgkin's disease (HD; n = 10) rec eived 12.0 Gy of fractionated TBI, etoposide 60 mg/kg, and Cy 100 mg/k g followed by infusion of autologous hematopoietic stem cells. Results : Thirty-one of 53 patients are alive a median of 643 (range, 177 to 1 ,144) days after transplant. The a-year Kaplan-Meier (K-M) estimates o f survival, event-free survival (EFS), and relapse for all 53 patients were 54%, 45%, and 43%, respectively. Sixteen of 24 patients with les s advanced disease and 10 of 29 patients with more advanced disease su rvive free of disease for K-M estimates of EFS of 61% and 31%, respect ively (P =.006). The K-M estimates of relapse were 34% for patients wi th less advanced disease and 53% (P =.05) for patients with more advan ced disease. The K-M estimates of dying from causes other than relapse were 8% in patients with less versus 25% in patients with more advanc ed disease (P =.09). Conclusion: These data indicate that approximatel y 60% of patients transplanted early after failure of initial therapy for malignant lymphoma are projected to be disease-free more than 2 ye ars after treatment with fractionated TBI, etoposide, and Cy and infus ion of autologous hematopoietic stem cells. The transplant-related mor tality rate is low and relapse is the main cause of treatment failure in patients with less advanced disease. For patients with more advance d disease, the K-M estimates of both transplant-related deaths (25%) a nd relapse (53%) remain major problems. (C) 1994 by American Society o f Clinical Oncology.