SHORT-TERM WEEKLY CHEMOTHERAPY FOLLOWED BY HIGH-DOSE THERAPY WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR LYMPHOBLASTIC AND BURKITT LYMPHOMAS IN ADULT PATIENTS

Background: Type and duration of treatment for highly aggressive non-H odgkin's lymphoma has been a matter of debate over the past decade. To determine the therapeutic efficacy of an abbreviated treatment regime n, 26 patients with newly-diagnosed highly aggressive lymphomas, 17 of them belonging to the International Working Formulation (IWF) group I and 9 with Burkitt's lymphoma (IWF J), were entered in a study using short-term weekly chemotherapy followed by high-dose therapy and autol ogous bone marrow transplantation. Patients and methods: Besides histo logy, requirements for entry into to the study were age between 16 and 60 years, stage I bulky disease and elevated LDH or stage II to IV di sease with or without bulk or elevated LDH, and an absence of HIV infe ction or CNS involvement at diagnosis. The treatment plan was 12 weeks of MACOP-B or VACOP-B chemotherapy followed by high dose therapy and autologous bone marrow transplantation in first complete remission. Re sults: Twenty patients (76%), 16 (62%) of those on MACOP-B or VACOP-B, 1 who had received 2 cycles of ProMACE-CytaBOM prior to MACOP-B and 3 after a first salvage reigmen, achieved complete remissions. Seventee n patients (65%) were transplanted in first remission, and 15 (58%) af ter induction treatment with only MACOP-B or VACOP-B. Reasons for not being given high dose therapy and autologous bone marrow transplantati on (ABMT) were failure to achieve complete remission in 6 patients, ea rly relapse in 2 and severe pulmonary toxicity associated with chemoth erapy in 1. The median time of follow-up was 45 months. At 3 years, th e estimated event-free survival was 31% (CI 14%-50%) and the overall s urvival 48% (CI 25%-67%). There were no deaths from toxic effects of t reatment. Pretreatment factors associated with relapse were stage III or IV disease, age over 30 years and bone marrow involvement. Logrank analysis showed that age was the only factor significantly associated with poor event-free survival. Conclusion: Short-term weekly chemother apy followed by high-dose therapy with the CBV regimen in first remiss ion is not a highly effective treatment for advanced lymphoblastic and Burkitt's lymphomas. The 30% rate of failure to achieve partial remis sion after 6 weeks and/or complete response after 12 weeks of MACOP-B or VACOP-B treatment, as well as the 42% failure rate to undergo ABMT in first remission, suggest that more aggressive chemotherapy should b e used in the beginning.