O. Fitoussi et al., Tandem transplant of peripheral blood stem cells for patients with poor-prognosis Hodgkins's disease or non-Hodgkin's lymphoma, BONE MAR TR, 24(7), 1999, pp. 747-755
Citations number
36
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
To improve the results of high-dose therapy with autologous stem cell trans
plantation, new conditioning regimens with acceptable toxicity must be deve
loped, The aim of this study was to evaluate the feasibility and toxicity o
f two myeloablative regimens performed at a 2-month interval. After salvage
chemotherapy and collection of peripheral stem cell progenitors (median CD
34(+) cells/kg: 11 x 10(6)/kg), (n = 15) patients with aggressive non-Hodgk
in's lymphoma with poor prognostic factors or refractory Hodgkin's disease
(n = 9) received intensified regimens. The first conditioning regimen, cons
isting of BCNU-cyclophosphamide-VP16-mitoxantrone was followed by transplan
tation of a median number of 4 x 10(6) CD34(+) cells/kg; then, after a medi
an interval of 56 days, a second preparative regimen, combining busulfan-ar
acytine-melphalan or TBI + aracytine-melphalan, was followed by transplanta
tion of a median of 4 x 106 CD34(+) cells/kg. After regimens 1 and 2, respe
ctively: median time to neutrophil recovery >500/mu l was 11 days (both tim
es); median time to platelet counts >50 000/mu l was 14 and 36 days, but va
lues >20 000/mu l were reached by days 13 and 16 (P = 0.9); mucositis grade
III-IV was observed in 11 and 15 cases. The median number of days with fev
er >38 degrees C was significantly higher (7.8 days) after the second trans
plant (P <0.05), Three cases of veno-occlusive disease (VOD) were observed
after the second transplant. At a median follow-up of 18 months, 14/24 (58%
) patients remained in CR, seven patients had died (two of VOD and five aft
er relapse) and two were alive in relapse. These results indicate that tand
em transplants performed at a 2-month interval in poor risk lymphoma can be
used with acceptable hematotoxicity. VOD remains the major drawback and he
patotoxic drugs, such as busulfan, should be used with caution. Longer term
followup of a larger cohort of patients is needed to ascertain the overall
efficacy.