Autologous stem cell transplantation for non-Hodgkin's lymphoma: comparison of radiation-based and chemotherapy-only preparative regimens

The aim of this study was to compare toxicity and efficacy of total body ir radiation (TBI), cyclophosphamide (CY) and etoposide (E) (TBI/CY/E) vs busu lfan, melphalan and thiotepa (Bu/Mel/T) in patients receiving autologous st em cell infusion (ASCI) for malignant lymphoma (NHL). Between September 199 0 and July 1998, 351 patients with NHL were treated with TBI/CY/E (n = 221) or Bu/Mel/T (n = 130) followed by ASCI. Patients in first, or second remis sion, first responding or untreated relapse were defined as having less adv anced disease before transplantation. The median follow-up was 5 years (ran ge 1-9) and 3.5 years (1-6) for patients receiving TBI/CY/E and Bu/Mel/T, r espectively. The cumulative probabilities of survival, event-free survival (EFS) and relapse at 5 years were 44%, 32%, 49% following TBI/CY/E and 42%, 34% and 42% following Bu/Mel/T. The probability of EFS at 5 years for pati ents who had prior dose-limiting radiation (n = 59) was 32% after Bu/Mel/T therapy. Transplant-related mortality was 16% for TBI/CY/E and 21% for Bu/M el/Y. In univariate and multivariate analyses, more advanced disease status was associated with poor outcome (TBI/CY/E: RR 0.70, CI 0.50 to 0.97 P = 0 .04; Bu/Mel/T: RR 0.61, CI 0.39 to 0.97 P = 0.03). No significant differenc es in toxicities and outcomes were observed between these two regimens desp ite the inclusion of patients who had received dose-limiting irradiation in the Bu/Mel/T regimen.