Intensified preparative regimens and allogeneic transplantation in refractory or relapsed intermediate and high grade non-Hodgkin's lymphoma

Between September 1986 and June 1998, 32 patients with relapsed or refracto ry intermediate or high grade lymphoma received intensified preparative the rapy and underwent allogeneic transplantation at a single institution. Pati ents were considered for allogeneic transplantation if they railed to respo nd to initial therapy, failed to respond to salvage therapy. relapsed after autologous transplantation, had bone marrow involvement. or failed attempt s to harvest autologous stem cells. Patients had a median age of 39 years a nd had generally received at least two chemotherapy regimens. Five year act uarial survival (S) was: 16% +/- 6%; median survival was 4 months. Survival was significantly worse in patients who had received high intensity brief duration chemotherapy prior to transplantation and was also significantly w orst in patients who did not receive total body irradiation (TBI). This lik ely reflects the fact that the patients with the most resistant disease had required local radiotherapy and could not receive TBI. While treatment rel ated mortality played a major role in limiting the: effectiveness or alloge neic transplantation, in this heavily pre-treated population of patients wi th resistant disease, only 39% of patients achieved a complete response fol lowing allogeneic transplantation, and in only 40% of that group was long t erm disease free survival achieved.