Is total body irradiation a necessary component of preparative therapy forautologous transplantation in non-Hodgkin's lymphoma

Between September 1986 and June 1998. 157 patients with low grade, intermed iate grade. or high grade lymphoma underwent autologous transplantation at a single institution. Two preparative regimens were used: cyclophosphamide. etoposide. total body irradiation (CY-VP-TBI) (N=110) and cyclophosphamide . BCNU. etoposide (CBV) (N=47). The two groups were not significantly diffe rent with respect to sourer of stem cells. gender. stage at presentation. i ncidence of prior bone marrow involvement. sensitivity to salvage therapy. or histologic grade of lymphoma. The CBV group was significantly older. 49% or patients over ape 50, as compared to 26% of patients over age 50 for th e CY-VP-TBI group. Response rates and the incidence of fatal toxicity were similar for the two groups. Five year actuarial survival was 31% +/- 9% for CBV and 38% +/- 5% for CY-VP-TBI. p =.85. In a multivariate analysis, ill which preparative regimen, age. histologic grade of lymphoma, and sensitivi ty to salvage therapy were the independent variables. TBI was not significa ntly associated with survival. and the direction of the trend was for TBI t o be less effective than CBV. TBI does not appear to be an essential compon ent of preparative therapy for autologous transplantation in patients with lymphoma.