BEAM CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH RELAPSED OR REFRACTORY NON-HODGKINS-LYMPHOMA

Purpose: To evaluate the outcome of patients with relapsed or resistan t non-Hodgkin's lymphoma (NHL) undergoing high-dose chemotherapy and a utologous bone marrow transplantation (ABMT) and to determine the main prognostic factors. Patients and Methods: One hundred seven patients with relapsed or resistant intermediate-/high-grade NHL underwent high -dose carmustine, etoposide, cytarabine, and melphalan (BEAM) chemothe rapy and ABMT at University College Hospitals between September 1981 a nd February 1993. The minimum follow-up duration of all patients is 6 months. Results: At 3 months, the overall response rate to BEAM and AB MT was 73% (41% complete response and 32% partial response). The 5-yea r actuarial overall survival and progression free survival rates were 41% and 35%, respectively. The early procedure-related mortality rate was 7% (eight of 107 patients). On multivariate analysis, the main pro gnostic factor was disease status at the time of ABMT. Patients with c hemosensitive disease had on actuarial 5-year survival rate of 49% at 5 years compared with 13% for those with chemoresistant disease (P < . 001). For patients considered to have chemosensitive disease at the ti me of transplantation, there is a significant difference in the actuar ial progression-free survival rates for those who received high-dose t herapy after attaining a partial response to first-line therapy (69% a t 5 years) os compared with those with sensitive but relapsed disease (32% at 5 years) (P = .003). Conclusion: Patients with chemosensitive disease benefit most from high-dose chemotherapy, and those who receiv e such therapy early after achieving a partial response to first-line therapy have a high rate of cure. (C) 1995 by American Society of Clin ical Oncology.