BONE-MARROW TRANSPLANTATION AFTER FAILURE OF AUTOLOGOUS TRANSPLANT FOR NON-HODGKINS-LYMPHOMA

We evaluated the response to and toxicity of allogeneic or autologous bone marrow transplantation (BMT) for patients with non-Hodgkin's lymp homa (NHL) who relapsed after autologous BMT. Since 1990, 172 patients have received autologous BMTs for NHL at the MD Anderson Cancer Cente r and 75 have relapsed. Twelve patients (median age, 42 years), with d isease recurrence underwent either allogeneic BMT (eight patients) or a second autologous BMT (four patients). Ten patients received thiotep a, busulfan and cyclophosphamide as conditioning, one patient received cyclophosphamide and total body irradiation and one received BCNU, et oposide, Ara-c and melphalan. The median interval between the first an d second transplants was 23.5 (range 5-80 months). Three patients who underwent allogeneic BMT had refractory relapses, three had a responsi ve relapse and two were in complete response (CR) at the time of BMT. Five patients received peripheral blood stem cells and three patients, allogeneic bone marrow. Three patients are alive and disease-free at 25, 22 and 7 months after allogeneic BMT. Four patients died of treatm ent-related causes and one from disease recurrence. All four patients undergoing autologous BMT had responsive relapses. Three patients rece ived peripheral blood stem cells and one patient bone marrow. Two pati ents are alive and disease-free at 12 and 30 months after autologous t ransplants. There were no treatment-related deaths; two patients died of disease recurrence. This retrospective study shows that in selected patients, allogeneic or autologous BMT is an effective salvage therap y for NHL which recurs after autologous BMT.