PROGNOSTIC FACTORS IN PATIENTS WHO RECEIVED AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA - REPORT OF 104 PATIENTS FROM THE SPANISH-COOPERATIVE-GROUP-GEL TAMO/

One hundred and four patients with low grade (9 patients), intermediat e grade (31 patients) and high grade (64 patients) non-Hodgkin's lymph oma received an autologous bone marrow transplantation (BMT). Disease status at transplant was first complete remission (CR) in 46 patients, second CR in 14 patients, third CR in 7 patients, chemosensitive dise ase in 16 patients and chemoresistant disease in 21 patients. Estimate d 5 year disease-free survival (DFS) for all 104 patients was 49% (95% confidence interval (CI), 36-63%) with a median follow-up of 24 month s. Five year relapse rate for 80 evaluable patients was 26% (95% CI, 1 4-44%). The 8 year DFS and relapse for the 46 patients transplanted in first CR were 75% (95% CI, 63-82%) and 15% (95% CI, 7-33%), respectiv ely, with a median follow-up of 27 months (range 13-104 months) and a median time to relapse of 5 months (range 4-20 months). In the univari ate analysis, variables correlated with DFS were performance status at autologous BMT, disease status at autologous BMT, LDH level at autolo gous BMT, failure to achieve CR at diagnosis, front-line chemotherapy (1 vs 2 or more regimens) and Working Formulation. Variables correlate d with relapse were disease status at autologous BMT, preparative regi men and Coiffer's index at diagnosis. Multivariate analysis showed tha t performance status was the only independent predictor of DFS and tha t disease status at autologous BMT was the best relapse predicting var iable. In patients transplanted in first CR, the variables correlated with DFS were stage at diagnosis and performance status at autologous BMT. LDH level at diagnosis was the only variable correlated with rela pse in patients transplanted in first CR, The overall mortality was 45 % (47 of 104). Twenty-eight patients (27%) died because of lymphoma an d the remaining 19 (18%) as a result of toxicity. Among patients in fi rst CR, 5 (10.8%) died in relapse and the other 5 because of toxicity. This series confirms the fact that the outcome of autologous BMT is b etter when performed early in the course of the disease. It is also no teworthy that well-known prognostic parameters at diagnosis which iden tify patients not likely to be cured with conventional chemotherapy (n amely, stage and LDH level) are also associated with a poor outcome af ter transplant in patients in first CR.