AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN ADULTS WITH NON-HODGKINS-LYMPHOMA - A SOUTHWEST-ONCOLOGY-GROUP

Patients with non-Hodgkin's lymphoma (NHL) who fail conventional chemo therapy have a dismal outcome. Reports from single institutions utiliz ing high-dose chemoradiotherapy plus Autologous Bone Marrow Transplant ation (ABMT) in this setting suggest three-year disease-free survival between 15-60 per cent. From 1985 to 1989 the Southwest Oncology Group performed a prospective multi-institutional study involving ABMT in r elapsed/refractory NHL. Forty-five patients, ages 6-60 (median 38), wi th relapsed NHL were treated with high-dose cyclophosphamide (60 mg/kg /d x 2), total body irradiation (200 cGy/d x 6), and autologous unpurg ed bone marrow. Histologic subtypes included high grade lymphoma (10), intermediate grade lymphoma (33), and low grade lymphoma (2). Disease status pre-ABMT was sensitive relapse (16), resistant relapse (13), a nd untreated relapse (16). The actuarial three-year event-free surviva l and overall survival for all patients were 27 per cent and 38 per ce nt respectively. Causes of failure included regimen-related deaths (4) , lack of response (10), or tumour progression (20) which occurred at a median of 5 months (1-22) post-ABMT and usually at previous sites of involvement. Response to salvage therapy pre-ABMT, a reflection of a tumour's biological behaviour, was the most important predictor of goo d outcome post-ABMT. This study confirms that a significant number of patients with recurrent NHL can achieve prolonged disease-free surviva l after ABMT.