Intensive chemotherapy with hematopoietic cell transplantation after ESHAPtherapy for relapsed or refractory non-Hodgkin's lymphoma. Results of a single-centre study of 65 patients

This study was designed to assess the results of protracted courses of ESHA P (etoposide, cyt arabine, cisplatin, methylprednisolone) therapy followed by intensive chemotherapy and hematopoietic cell transplantation (IC+HCT) f or relapsed or refractory non-Hodgkin's lymphoma (NHL). Treatment consisted of 3 cycles of ESHAP; responsive patients (pts) then received 3 more cycle s, and IC+HCT was used for pts in maintained partial (PR) or complete (CR) remission after the sixth ESHAP. Sixty-five pts entered the study. At enrol lment, 27 pts had bone marrow (BM) and/or central nervous system (CNS) lymp homatous infiltration. Disease status was primary refractory lymphoma in 41 pts (63%), and relapse in 24 pts (37%). Results showed that two pts were n ot evaluable for the therapeutic response because of early treatment-relate d death. Thirty-nine (62%) pts entered PR or CR after 3 cycles of ESHAP. El even pts subsequently had disease progression. Twenty-eight pts were in per sistent CR or PR after 6 cycles of ESHAP. Refractory pts did not show a dif ferent response rate to relapsing pts (chi(2) = 1.73). Five pts were exclud ed from IC+HCT because of an inadequate graft or treatment-related toxicity . Twenty-three (35%) pts completed the procedure. Five pts (22%) relapsed a fter IC+HCT. The overall survival rate of the 39 responsive pts is 45% at 6 0 months, with a median survival time of 30 months. Median survival among t he 35 pts in whom second-line chemotherapy failed is 7.1 months, with a 4-y ear survival rate of 3%. Despite the poor prognostic features of this group , 45% of pts responding to the first 3 cycles of chemotherapy are in prolon ged remission, suggesting that rather than to transplant after just 2 cycle s of salvage therapy, pursuing second-line chemotherapy may better discrimi nate between patients more likely to benefit from a subsequent transplant.