AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH RELAPSED OR REFRACTORY DIFFUSE AGGRESSIVE NON-HODGKINS-LYMPHOMA - VALUE OF AUGMENTED PREPARATIVE REGIMENS - A SOUTHWEST-ONCOLOGY-GROUP TRIAL

Purpose: To determine the toxicity and prognosis of patients with rela psed and refractory diffuse aggressive non-Hodgkin's lymphoma (NHL) wh o underwent an autologous bone marrow transplant (ABMT) using augmente d preparative regimens, treated in a major cooperative group setting, and to examine prognostic factors for outcome. Patients and Methods: N inety-four patients with either chemosensitive (50 patients) or chemor esistant (44 patients) relapse, including 22 who failed induction chem otherapy, were treated with high-dose cyclophosphamide and etoposide w ith total-body irradiation (TBI) (67 patients) or an augmented carmust ine (BCNU), cyclophosphamide, and etoposide (BCV) preparative regimen (27 patients) and an ABMT at 16 Southwest Oncology Group (SWOG) transp lant centers. All relapsing patients were required to undergo a minimu m of two courses of salvage therapy to determine chemosensitivity befo re transplant. Overall (OS) and progression-free survival (PFS) were d etermined and a Cox regression model was used to assess potential prog nostic variables. Results: Of the 94 eligible patients, there were 10 (10.6%) deaths before day 50 posttransplant because of infection (six deaths), hemorrhagic alveolitis (three deaths), or bleeding (one death ). The median 3-year PFS and OS for the entire group was 33% and 44%. For those with chemosensitive disease the PFS and OS were 42% and 55%, whereas for those with chemoresistant disease the PFS and OS were 22% and 29%. The PFS and OS far those failing induction chemotherapy were 27% and 32%. The relapse rates within the first 3 years for the chemo sensitive relapse, chemoresistant, and induction failure groups were 6 1%, 40%, acid 59%, respectively. For both PFS and OS, only disease sta tus at transplant was a significant factor in the multivariate Cox mod el. Conclusion: These results single institutional pilot trials explor ing augmented preparative regimens, patients undergoing transplantatio n for resistant disease, particularly chose failing induction chemothe rapy, appear to have on improved prognosis as compared with reports us ing standard preparative regimens. Therapies other than manipulation o f standard preparative regimens appear to be required to decrease rela pses following autotransplantation. (C) 1998 American Society of Clini cal Oncology.