BUSULFAN, CYCLOPHOSPHAMIDE AND ETOPOSIDE AS HIGH-DOSE CONDITIONING THERAPY IN PATIENTS WITH MALIGNANT-LYMPHOMA AND PRIOR DOSE-LIMITING RADIATION-THERAPY

Relapse after transplant for malignant lymphomas remains the main caus e of treatment failure, Most conditioning regimens contain total body irradiation (TBI), We investigated the toxicity and efficacy of an int ensified chemotherapy conditioning regimen without TBI in patients wit h relapsed or high-risk malignant lymphoma who had received prior radi ation therapy and were therefore not eligible for TBI, Twenty patients with a median age of 38 (18-56) and relapsed or highrisk malignant no n-Hodgkin's lymphoma (NHL, n = 16) or Hodgkin's disease (HD, n = 4) un derwent high-dose chemotherapy consisting of busulfan (16 mg/kg), cycl ophosphamide (120 mg/kg) and etoposide 30 mg/kg (n = 8) Or 45 mg/kg (n = 12) followed by peripheral seem cell support (n = 14), autologous b one marrow (n = 3), allogeneic (n = 2) or syngeneic (n = 1) transplant ation. All but two had chemosensitive disease before high-dose chemoth erapy, The main toxicity - according to the Bearman score - was mucosi tis II in 18 (90%) patients; five patients (25%) suffered a grade I he patic toxicity, GI toxicity I occurred in three (15%) and renal toxici ty I in two patients (10%), Sixty percent of the patients developed tr ansient dermatitis with erythema and three of them (15%) had skin desq uamation; one patient experienced asymptomatic pancreatitis, Toxicity was slightly higher in patients treated with 45 mg/kg etoposide, One p atient (5%) died of treatment-related venoocclusive disease. After a m edian follow-up of 50 months (24-84) the disease-free and overall surv ival were 50% and 55%. One of the nine relapsing patients developed se condary AML 18 months after transplant. High-dose busulfan, cyclophosp hamide and etoposide is an effective regimen resulting in long-term di sease-free survival in 50% of patients with relapsed malignant lymphom a and prior radiation therapy, The toxicity is moderate with a low tre atment-related mortality (5%).