A NOVEL HIGH-DOSE CHEMOTHERAPY PROTOCOL WITH AUTOLOGOUS HEMATOPOIETICRESCUE IN PATIENTS WITH METASTATIC BREAST-CANCER OR RECURRENT NON-HODGKINS-LYMPHOMA

In this phase II trial, we used a double dose-intensive chemotherapy a nd stem cell rescue protocol to treat breast cancer (BCA) patients or non-Hodgkin's lymphoma patients (NHL), The first cycle consisted of hi gh-dose melphalan followed by ABMT, The second cycle used a novel chem otherapy combination; thiotepa, etoposide, carboplatin and cyclophosph amide (TECC) followed by ABMT. We treated 12 patients in total, nine w ith BCA, three with NHL, All nine BCA patients were treated with the t wo cycle protocol, The three NHL patients were treated with the second cycle only, Bone marrow (BM, 1 patient), peripheral blood stem cells (PBSC, 10 patients) or both (1 patient) were reinfused 60-72 h after c ompletion of each cycle of chemotherapy. Recovery was rapid; the ANC r ose to greater than 500/mu l on day +11 (+8 to +20) and the platelet c ount to greater than 20000/mu l on day +12 (+6 to +20), The toxicities included the expected neutropenic fevers, severe mucositis, diarrhea, and a low incidence of mild renal insufficiency, No patients develope d veno-occlusive disease, hemorrhagic cystitis or overt bleeding, With a mean follow-up of 37 months, 83.3% of the patients are alive, Six p atients are in complete remission; one patient with BCA relapsed and e xpired; one patient with NHL is in CR now over 18 months after relapse and subsequent treatment with interferon; one patient is too early to evaluate, Progression-free survival overall is 75%, which is at least equivalent to many other recent studies using similar regimens, In ad dition, we have also found that delayed addition of G-CSF during the m obilization of PBSC was feasible and resulted in excellent CD34(+) cel l counts and engraftments, and reduced treatment costs, These results indicate that this chemotherapy is effective with good remission rates and high progression-free survival rates, It is also well tolerated w ith acceptable toxicities that are manageable, Long-term follow-up of a larger cohort of patients will be needed to ascertain the overall ef ficacy of this type of therapy.