AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN POOR-RISK HIGH-GRADE NON-HODGKINS-LYMPHOMA IN FIRST COMPLETE REMISSION

We report the safety and efficacy of autologous bone marrow transplantation (ABMT) in 30 patients with high-grade non-Hodgkin's lymphoma (NHL) in first complete remission (CR1) following remission induction chemotherapy. Two patients relapsed prior to ABMT. All patients were conditioned with high-dose melphalan. In addition, ten received fractionated total body irradiation, one hemi-body irradiation and four high-dose etoposide. Unmanipulated non-cryopreserved autologous marrow was reinfused within 56h of harvesting. Engraftment occurred in all patients with a median of 11 days of neutropenia (<0.5 x 10(9) 1(-1)), a median requirement for platelet transfusion of 3 days and packed red cell transfusion of 2 units, with a median hospital stay of 18 days post transplant. There was no procedure-related mortality and only minor morbidity was observed. Two patients relapsed at 1 and 2 months post transplantation, and one patient died of carcinoma of the lung 33 months after transplantation. The remaining 25 patients remain alive, well and in CR1 with a median follow-up of 44 months. The event-free survival at 3 years for all patients considered for ABMT was 83%. We conclude that ABMT for high-grade NHL in CR1 with noncryopreserved marrow results in rapid haematoiogical recovery without growth factor support. It is safe and is associated with high survival when used as consolidation of CR in high-risk patients.