CYTOSINE-ARABINOSIDE AND ETOPOSIDE (CARE) IN RELAPSED AND REFRACTORY NON-HODGKINS-LYMPHOMA

Twelve patients with relapsed or refractory non-Hodgkin's lymphoma (NH L) were treated with a 5 day protocol of high dose cytosine arabinosid e 3g/m2 and etoposide 200 mg/m2(CARE) daily for 4 days for either 1 or 2 cycles together with alternating intrathecal cytosine arabinoside a nd methotrexate. Seven men and 5 women aged 18 to 65 years (median age 47.5 years) have received a total of 19 cycles. Six patients had Stag e III and 6 had Stage IV disease, all with marrow involvement. Three p atients had diffuse small lymphocytic NHL, 3 had diffuse large cell NH L, 3 had diffuse small cleaved NHL and 3 remaining patients had diffus e mixed small and large cell NHL, lymphoblastic NHL and Burkitt's. Six patients (50%) achieved complete remission (3-44 months), four of who m subsequently underwent successful autologous bone marrow transplanta tion and a fifth has had marrow harvested in preparation for ABMT. One patient achieved partial remission and 5 patients had no response to CARE. Ten patients had nadir granulocyte counts less than 0.5x10(9)/l and all required red cell (range 2-11 units) and platelet (range 6-130 units) transfusions. The platelet nadir was less than 20x10(9)/l in a ll patients. One patient with refractory disease succumbed to pulmonar y haemorrhage while three other patients developed reversible toxicity with severe mucositis, prolonged diarrhoea and acute renal failure. O ne patient with refractory disease died with a progressive neuropathy.