High-dose cyclophosphamide followed by autografting can improve the outcome of relapsed or resistant non-Hodgkin's lymphomas with involved or hypoplastic bone marrow

We report our experience of high-dose cyclophosphamide (HDCY) followed by h igh-dose therapy (HDT) and peripheral blood progenitor cell (PBPC) autograf ting in patients with diffuse, intermediate and high-grade non-Hodgkin's ly mphomas who have failed conventional treatment. From 1991 to 1996, 54 conse cutive patients pre-treated with a median of two chemotherapy lines entered the study. Eighteen patients (33%) were still responders to conventional c hemotherapy (sensitive relapse), and 20 patients (37%) were in partial resp onse (PR) after chemotherapy (CT). Sixteen patients (30%) were resistant to conventional CT either at presentation (non responder) or in relapse (resi stant relapse). Thirty-nine patients had bone marrow involved by disease an d fifteen had an hypoplastic marrow following conventional treatment. Patie nts received HDCY (7gr/m(2)) and G-CSF or GM-CSF in order to collect PBPC. Median collected CD34(+) cells was 12.3 x 10(6)/Kg (range 0.7-197). After H DT (BEAM or Melphalan + TBI) 50 patients underwent PBPC autografting. Accor ding to intention to treat, 44 (81%) of 54 patients achieved complete remis sion (CR) (50% after HDCY and 31% after HDT). Procedure related death occur red in 6 patients (11%), one after HDCY and 5 after autografting. Twenty-ni ne (66%) of 44 patients an still in CR, 7 to 63 months (median 27 months) a fter the procedure. Three-year probability of survival, disease-free surviv al and progression-free survival are 63%, 64% and 52% respectively. In conc lusion, HDCY is an effective procedure not only in mobilizing PBPC, but als o in reducing tumour burden. HDT with PBPC support may further improve the outcome in this category of high-risk non-Hodgkin's lymphomas.