SALVAGE CHEMOTHERAPY WITH MINI-BEAM FOR RELAPSED OR REFRACTORY NON-HODGKINS-LYMPHOMA PRIOR TO AUTOLOGOUS BONE-MARROW TRANSPLANTATION

Background: The role of intensive chemotherapy with autologous blood a nd marrow transplantation (ABMT) for patients with relapsed or refract ory intermediate grade non-Hodgkin's lymphoma has recently been establ ished. However, conventional dose salvage chemotherapy is frequently u sed to determine chemotherapy sensitivity and reduce tumor bulk prior to intensive therapy. Different salvage regimens have been proposed bu t none appears significant superior. The purpose of this study was to determine the efficacy of mini-BEAM salvage chemotherapy in patients r eferred for ABMT and to define prognostic factors of response. Patient s and methods: One hundred four patients referred for consideration of ABMT after failure of primary anthracycline-based chemotherapy receiv ed BCNU 60 mg/m(2) day 1, etoposide 75 mg/m(2) day 2-5, ara-C 100 mg/m (2) q12h day 2-5, melphalan 30 mg/m(2) day 6 (mini-BEAM) until maximum tumor reduction. Median age was 52 (range 18-65); 57% had failed to a chieve a complete response (CR) to doxorubicin-based chemotherapy at d iagnosis and only 13% had a previous CR lasting > 12 months. Seventy-s ix received mini-BEAM as first salvage chemotherapy. Results: The over all response rate (RR) was 37% (95% confidence interval (CI) 28-46%) w ith 12 patients achieving CR and 25 achieving PR. The response rate am ong patients treated as first salvage was 43% compared to 20% for pati ents who had failed to respond to a previous salvage regimen. Only 15% of patients who failed to respond to mini-BEAM responded to another c onventional dose salvage regimen. Thirty-eight of 104 patients ultimat ely demonstrated sufficient response to proceed to ABMT. Actuarial sur vival at four years is 22% for all 104 patients, and 36% for those who went on to ABMT For those who were not transplanted, four-year surviv al was 18%. B symptoms and tumor burden at relapse were significant pr edictors of response to mini-BEAM in multivariate analysis, and identi fied a poor prognosis group of patients unlikely to be cured by this a pproach. Conclusions: Mini-BEAM does not appear to be a superior salva ge regimen in this high-risk group of relapsed or refractory NHL patie nts for whom ABMT was the ultimate treatment intention. Only one-third of patients referred for ABMT ultimately proceed to transplant; alter native treatment strategies should be developed for those with a low l ikelihood of cure by this approach.