High-dose therapy and autologous transplantation for lymphoma: The Peter MacCallum Cancer Institute experience

Background: High-dose therapy (HDT) with autologous bone marrow or blood ce ll transplantation for the treatment of lymphoma commenced at Peter MacCall um Cancer Institute in 1986. Aim: To examine the patient characteristics and outcomes of patients with n on-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) treated with HDT and autologous transplantation at our Institute in the first 10 years of the s ervice (1986-95). Methods: A retrospective analysis was performed examining patient character istics, prior chemotherapy regimens, pretransplant disease status, HDT regi men, source of stem cells, time for haematopoietic recovery, complications of transplantation, response rates, overall survival (OS) and progression-f ree survival (PFS). Results: Sixty-seven patients with NHL were treated with an estimated 5-yea r OS rate of 44% (95% confidence interval (CI) 32-56%) and PFS rate of 34% (95% CI 21-44%). Factors independently predictive of an unfavourable PFS on multivariate analyses were presence of constitutional symptoms at transpla nt (P < 0.002) and chemotherapy-resistant disease at transplant (P = 0.02). Twenty-three patients with HD were treated with a 5-year predicted OS rate of 74% (95% CI 56-92%) and PFS rate of 57% (95% CI 36-77%). There was no d ifference in PFS for HD patients who relapsed either within 12 months of co mpletion of front-line therapy or after this time (P = 0.5). The transplant -related mortality for the entire cohort was 17%, with a progressive decrea se over time. Conclusion: HDT with autologous transplantation achieves durable PFS and OS in patients with lymphoma. Improved patient selection, therapy modificatio ns according to prognostic factors and ongoing improvements in supportive c are should improve outcomes further.