HIGH-DOSE CYCLOPHOSPHAMIDE, CARMUSTINE, AND ETOPOSIDE FOLLOWED BY ALLOGENEIC BONE-MARROW TRANSPLANTATION IN PATIENTS WITH LYMPHOID MALIGNANCIES WHO HAD RECEIVED PRIOR DOSE-LIMITING RADIATION-THERAPY

Purpose: To evaluate a high-dose chemotherapy regimen without total-bo dy irradiation (TBI) followed by allogeneic (allo) bone marrow transpl antation (BMT) in patients with lymphoid malignancies who had received prior dose-limiting radiotherapy. Patients and Methods: Fifty-six pat ients with non-Hodgkin's lymphoma (NHL, n = 26), Hodgkin's disease (HD , n = 17), or acute lymphoblastic leukemia (ALL, n = 13) with a histor y of previous radiation therapy were treated with cyclophosphamide (7. 2 g/m(2)), carmustine (300 mg/m(2) or 600 mg/m(2)), and etoposide (2,4 00 mg/ m(2); CBV) followed by allo BMT. Results: Nine of 56 patients a re alive and disease-free a median of 1,091 (range, 512 to 1,784) days posttransplant. The probabilities of transplant-related mortality, re lapse, and event-free survival at 2 years for the entire group of 56 p atients were .62, .59, and .17, respectively. Patients who received 60 0 mg/m(2) of carmustine had a higher incidence of grade 3 or 4 regimen -related toxicities (RRTs) (14 of 22) than did patients who received 3 00 mg/m(2) (12 of 33; P < .04), whereas there was no difference in rel apse (.34 and .53, respectively, P = .73). Fourteen of 16 patients who received allo BMT for advanced disease (n = 12) or less-advanced dise ase (n = 4) but who were also eligible for auto BMT relapsed (n = 4) o r died of transplant-related complications (n = 10). Conclusion: Allo BMT following a high-dose CBV regimen resulted in long-term disease-fr ee survival in 17% of patients with lymphoid malignancies who had rece ived prior dose-limiting radiotherapy. A high incidence of transplant- related complications, especially fatal idio pathic pneumonia syndrome (IFS) and a high relapse rate limited success. Morbidity and mortalit y associated with carmustine 600 mg/m(2) were high and were not associ ated with a decrease in relapse. The number of patients in this study eligible for either allo or auto BMT was limited and precluded meaning ful analysis of relative effectiveness. (C) 1995 by American Society o f Clinical Oncology.