HIGH-DOSE CYCLOPHOSPHAMIDE, ETOPOSIDE AND BCNU (CVB) WITH AUTOLOGOUS STEM-CELL RESCUE IN MALIGNANT-LYMPHOMAS

Eighteen patients with malignant lymphoma, 10 non-Hodgkin's and 8 Hodg kin's, were treated with high-dose CVB (cyclophosphamide 4 x 1.5 g/m2, etoposide 4 x 250-400 mg/m2, carmustine 4 x 150-200 mg/m2), followed by autologous peripheral blood stem cells (PBSC, 13 patients) or bone marrow (BM, 5 patients) transplantation. At the time of autograft 6 pa tients were in complete remission (CR), 3 in partial remission (PR) an d 5 in relapse (4 sensitive, 1 resistant), whereas 4 had progressive d isease. All CR patients had poor prognostic features at presentation. PBSC were collected at the time of rapid hematologic recovery after in tense chemotherapy by means of a cell separator. All patients engrafte d. Median time to achieve greater-than-or-equal-to 0.5 x 10(9)/l polym orphonuclear cells (PMN) and greater-than-or-equal-to 50 x 10(9)/l pla telets was 13 days for both cell types in PBSC autografted patients, v ersus 20 and 28 days respectively in BM autografted patients. A signif icant advantage of PBSC over BM was found in terms of time needed to r ecover either PMN greater-than-or-equal-to 0.5 and PMN greater-than-or -equal-to 1 x 10(9)/l (p = 0.01). Autograft-related toxicity consisted mainly of moderate severity interstitial pneumopathy (3 patients), an d veno-occlusive disease (1 patient) that resolved completely. Of the 12 patients autografted with detectable disease, 6 (50%) obtained a CR . Seven out of 18 autografted patients (39%) had disease progression w ithin 1 to 5 months of autograft. The projected progression-free survi val is over 50% at 4 years and it was significantly longer in patients with sensitive disease than in those with resistant disease (p = 0.01 ). The efficacy and the low toxicity of CVB suggest that autograft wit h PBSC may be proposed for the primary treatment of poor prognosis mal ignant lymphomas.