IMPACT OF HIGH-DOSE SALVAGE THERAPY (BEAM) ON OVERALL SURVIVAL IN YOUNGER PATIENTS WITH ADVANCED LARGE-CELL LYMPHOMAS ENTERED INTO BNLI TRIALS

The survival of two cohorts of patients with stage III/IV large-cell l ymphomas treated by CHOP has been compared. In the first cohort of 88 patients (1974-1982), high-dose therapy with autologous bone marrow tr ansplantation (ABMT) aias not available as salvage therapy and in the second cohort of 87 patients (1987-1992), this was the recommended sal vage for patients with disease that was still chemosensitive to conven tional-dose therapy. The actuarial overall survivals at five years wer e 40% and 44% in the first and second cohorts, respectively, indicatin g that the availability of ABMT had made little impact. Of the 62 pati ents in the second cohort mho failed CHOP therapy, 8 died before secon d-line chemotherapy could be given, 1 refused more therapy, and 8 were considered unsuitable for further combination chemotherapy Seven pati ents with localized disease remaining received local radiotherapy. Of the 38 patients giver. salvage therapy, 14 had chemoresistant disease. Only 9 patients received high-dose BEAM chemotherapy and ABMT, and 7 remain disease-free. ABMT was restricted to a highly select patient gr oup, and as a result more widespread application of this strategy migh t result in only a modest further improvement.