AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMAS - THEROLE OF GRAFT PURGING AND RADIOTHERAPY POSTTRANSPLANTATION - RESULTS OF A RETROSPECTIVE ANALYSIS ON 120 PATIENTS AUTOGRAFTED IN A SINGLE INSTITUTION

Purpose: To analyze retrospectively survival and prognostic factors of patients with non-Hodgkin's lymphoma (NHL) autografted from 1979 to 1 995 in a single institution. Patients and Methods: A total of 120 pati ents, 64 with aggressive and 56 with low-grade NHL, were autografted. The carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) reg imen was used in 104. The autograft was marrow in 101 patients. Marrow was purged in vitro by mafosfamide for 63 patients (adjusted dose [AD ] in 32; unique dose [UD] in 31); 27 patients received a CD34(+)-selec ted graft. Following intensification, 45 patients received additional radiotherapy on previous sites of involvement. Results: Outcome at 5 y ears for patients transplanted with low-grade NHL in first complete re mission (CR1), in first partial remission (PR1), and in second complet e remission (CR2) or beyond showed an event-free survival (EFS) of 75% +/- 12%, 46% +/- 18%, and 57% +/- 24%, a relapse incidence (RI) of 21 % +/- 12%, 49% +/- 19%, and 43% +/- 25%, and a transplant-related mort ality (TRM) of 5% +/- 5%, 10% +/- 7%, and 0%, respectively. For patien ts with aggressive NHL transplanted in CRI, in PR1, in CR2 or beyond, and in resistant relapse or in primary refractory disease, the EFS was of 73% +/- 9%, 58% +/- 19%, 29% +/- 16%, and 10% +/- 9%, the RI 22% /- 9%, 14% +/- 9%, 77% +/- 18%, and 66% +/- 20%, and the TRM 6% +/- 6% , 32% +/- 21%, 11% +/- 10%, and 71% +/- 22%, respectively. In patients autografted upfront in first remission, additional radiotherapy was a ssociated with a higher EFS, in univariate (P = .03) and multivariate analysis (P = .02, relative risk [RR] = .021). The role of graft purgi ng with mafosfamide on the outcome reflected by the dose of colony-for ming unit-granulocyte-macrophage (CFU-GM) per kilogram infused postpur ging was assessed by univariate analysis: patients in first remission who received lower doses of CFU-GM had a lower RI and a higher EFS. Co nclusion: This retrospective analysis suggests that marrow purging and posttransplant radiotherapy improve the outcome of patients with NHL autografted in first remission. J Clin Oncol 16:2803-2816. (C) 1998 by American Society of Clinical Oncology.