Tandem transplant of peripheral blood stem cells for patients with poor-prognosis Hodgkins's disease or non-Hodgkin's lymphoma

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.