TREATMENT OF PATIENTS WITH RELAPSED AND RESISTANT NON-HODGKINS-LYMPHOMA USING TOTAL-BODY IRRADIATION, ETOPOSIDE, AND CYCLOPHOSPHAMIDE AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION

被引:117
作者
GULATI, S [1 ]
YAHALOM, J [1 ]
ACABA, L [1 ]
REICH, L [1 ]
MOTZER, R [1 ]
CROWN, J [1 ]
TOIA, M [1 ]
IGARASHI, T [1 ]
LEMOLI, R [1 ]
HANNINEN, E [1 ]
DOHERTY, M [1 ]
机构
[1] MEM SLOAN KETTERING CANC CTR, DEPT RADIAT ONCOL, NEW YORK, NY 10021 USA
关键词
D O I
10.1200/JCO.1992.10.6.936
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Patients with non-Hodgkin's lymphoma (NHL) who do not achieve a complete response (CR) after induction chemotherapy or who relapse after achieving a CR are rarely cured of their disease by the usual salvage therapy. Success of high-dose cytotoxic therapy with an autologous bone marrow transplant (AuBMT) is limited. We describe the results of a prospective single-institution study using a new conditioning regimen for patients with relapsed or resistant NHL who underwent AuBMT. Patients and Methods: Forty-four patients were reinduced with cytotoxic therapy and then evaluated for response. All patients received the conditioning regimen of hyperfractionated total body irradiation (TBI), etoposide (VP-16), and cyclophosphamide (CTX) followed by autologous bone marrow reinfusion. Results: The disease-free survival (DFS) rate was 57% with a median follow-up of 42+ months. The only variable significantly associated with DFS was the patient's remission status at AuBMT. Patients who underwent AuBMT in CR had a DFS of 80%, whereas patients who underwent AuBMT in partial response (PR) or with progressive disease (PD) had a DFS of 60% and 11%, respectively (P = .002). The major toxicity was hemorrhage at the she of bulky disease, especially in patients with residual mediastinal and/or pulmonary disease. Conclusion: Planned reinduction cytotoxic therapy followed by TBI, VP-16, and CTX with AuBMT is an effective treatment for patients with relapsed and resistant NHL. © 1992 by American Society of Clinical Oncology.
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页码:936 / 941
页数:6
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