Limited efficacy of intensified preparative regimens and autologous transplantation as salvage therapy in high grade non-Hodgkin's lymphoma

Between 9/86 and 6/98, 22 patients with relapsed or refractory high grade l ymphoma received intensified preparative therapy and underwent autologous t ransplantation at a single institution. Two intensified preparative regimen s were used - cyclophosphamide, etoposide, total body irradiation (CY-VP-TB I) (N=17) and cyclophosphamide, BCNU, etoposide (CBV) (N=5). For all patien ts undergoing autologous transplantation, 5 year actuarial survival (S) and 5 year event free survival (EFS) were only 18% +/- 8%. Treatment related m ortality was 14% overall but only 8% in patients receiving G-CSF or GM-CSF. Survival was significantly inferior to the survival observed in a concurre nt series of patients with intermediate grade lymphoma, 34% +/- 6%, p < .05 . Using high dose therapy in conjunction with autologous transplantation at the time of relapse may not be as valuable a strategy in high-grade lympho ma as in intermediate grade lymphoma although most studies combine the two disorders. Alternative strategies for the use of transplantation in high gr ade lymphoma, such as the use of transplantation as consolidation therapy, need to be investigated.