Abstract
Patients with non‐Hodgkin's lymphoma (NHL) who fail conventional chemotherapy have a dismal outcome. Reports from single institutions utilizing high‐dose chemoradiotherapy plus Autologous Bone Marrow Transplantation (ABMT) in this setting suggest three‐year disease‐free survival between 15–60 per cent. From 1985 to 1989 the Southwest Oncology Group performed a prospective multi‐institutional study involving ABMT in relapsed/refractory NHL.
Forty‐five patients, ages 6–60 (median 38), with relapsed NHL were treated with high‐dose cyclophosphamide (60 mg/kg/d × 2), total body irradiation (200 cGy/d × 6), and autologous unpurged bone marrow. Histologic subtypes included high grade lymphoma (10), intermediate grade lymphoma (33), and low grade lymphoma (2). Disease status pre‐ABMT was sensitive relapse (16), resistant relapse (13), and untreated relapse (16).
The actuarial three‐year event‐free survival and overall survival for all patients were 27 per cent and 38 per cent respectively. Causes of failure included regimen‐related deaths (4), lack of response (10), or tumour progression (20) which occurred at a median of 5 months (1–22) post‐ABMT and usually at previous sites of involvement. Response to salvage therapy pre‐ABMT, a reflection of a tumour's biological behaviour, was the most important predictor of good outcome post‐ABMT.
This study confirms that a significant number of patients with recurrent NHL can achieve prolonged disease‐free survival after ABMT.