THE TREATMENT OF RELAPSED OR REFRACTORY INTERMEDIATE GRADE NON-HODGKINS-LYMPHOMA WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOLLOWED BY CYCLOSPORINE AND INTERFERON

In an effort to decrease the relapse rate following autologous bone ma rrow transplantation for non-Hodgkin's lymphoma, patients were given c yclosporine and interferon following autologous marrow transplantation . Forty patients with intermediate grade non-Hodgkin's lymphoma that w as relapsed or refractory to standard chemotherapy underwent autologou s marrow transplantation. The preparative regimen consisted of cycloph osphamide 6.8 g/m(2), etoposide 1600 mg/m(2), and carmustine 400 mg/m( 2) over 4 days followed by reinfusion of bone marrow. Intravenous cycl osporine was started on day -1 as a 16 mg/kg loading dose followed by 3.6 mg/kg/day for 28 days after transplant. Patients were begun on alp ha-interferon (starting dose, 0.5 million units s.c. every other day) following platelet engraftment (median day 24 post-transplant) and con tinued on 1.5 million units s.c. daily for 2 years. Regimen-related to xicities resulted in four (10%) deaths. Twenty-one (53%) patients deve loped marked erythema of the palms, soles, and arms. Biopsies of the e rythema were consistent with grade I GVHD. Patients who did not develo p rashes were not biopsied. The erythema persisted for a median of 10 days and resolved in all cases without treatment. Visceral GVHD was no t apparent. All patients have been followed for a median of 24 months (range 12-54 months). To date, only five patients (13%) have relapsed after bone marrow transplant. Multivariant analysis could not identify risk factors for relapse post-transplant. Disease-free survival of al l patients is 77% (95% confidence interval, 67-93%). The results of th is pilot study suggest that the administration of cyclosporine and int erferon may decrease the relapse rate of relapsed/refractory non-Hodgk in's lymphoma following autologous bone marrow transplantation.