HIGH-DOSE SEQUENTIAL (HDS) CHEMOTHERAPY WITH BLOOD AND MARROW CELL AUTOGRAFT AS SALVAGE TREATMENT IN VERY POOR-PROGNOSIS, RELAPSED NON-HODGKINS-LYMPHOMA

We tested the feasibility and efficacy of a novel high-dose sequential chemoradiotherapy programme (HDS) in 14 relapsed or refractory non-Ho dgkin's lymphoma patients with very poor prognostic features, i.e. tra nsformed histology, marrow invasion, low performance status. This regi men included the sequential administration of high-dose cyclophosphami de (CY) 7 g/m(2) followed by high-dose methotrexate (MTX) 8 g/m(2) and high-dose VP16 2 g/m(2) and finally by total body irradiation (TBI)-m elphalan and autograft of bone marrow and peripheral blood progenitor cells. No hemopoietic growth factor support was employed in any phase. There was one treatment-related death during the high-dose phase; thr ee other patients did not complete the programme. All 10 patients conc luding the programme achieved complete remission, with four patients i n complete clinical remission at a median follow up of 34 months. Medi an overall survival was 27 months and median failure-free survival (FF S) was 12 months. Twenty-six well comparable patients received convent ional salvage therapy during the same period. Their projected median o verall survival (8 months) and median FFS (4 months) were shorter than in the HDS group (p = 0.06 for overall survival and p = 0.03 for FFS) . Thus, HDS is a feasible programme and may offer superior results tha n conventional therapy in poor-prognosis NHL patients.