High-dose chemotherapy with tandem autologous transplantation as part of the initial therapy for aggressive non-Hodgkin's lymphoma

• Published in: International journal of oncology Vol. 17; no. 5; p. 1007
• Main Authors: Ballestrero, A, Clavio, M, Ferrando, F, Gonella, R, Garuti, A, Sessarego, M, Ghio, R, Gobbi, M, Patrone, F
• Format: Journal Article
• Language: English
• Published: Greece 01.11.2000
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Disease-Free Survival; Etoposide - administration & dosage; Feasibility Studies; Female; Hematopoietic Cell Growth Factors - therapeutic use; Hematopoietic Stem Cell Transplantation; Humans; Life Tables; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - pathology; Lymphoma, Non-Hodgkin - radiotherapy; Lymphoma, Non-Hodgkin - therapy; Male; Melphalan - administration & dosage; Middle Aged; Mitoxantrone - administration & dosage; Remission Induction; Salvage Therapy; Survival Analysis; Survival Rate; Treatment Outcome
• ISSN: 1019-6439
• DOI: 10.3892/ijo.17.5.1007

The purpose of the present study was to evaluate the feasibility and the efficacy of employing a high-dose chemotherapy (HDT) regimen with tandem peripheral blood progenitor cells (PBPC) supported transplantation in the initial treatment of aggressive non-Hodgkin's lymphoma (NHL). HDT was preceded by a standard course of conventional dose chemotherapy in 17 out of the 25 patients treated, while in 8 cases it was delivered after only one or two cycles. HDT was a three-step procedure which included high-dose (6-7 g/m2) cyclophosphamide (CY) supported by haematopoietic growth factors, the first myeloablative course with mitoxantrone (NOV) 60, 75 or 90 mg/m2 plus melphalan (L-PAM) 140-180 mg/m2 with haematopoietic rescue, and the second myeloablative course with etoposide (VP) and carboplatin (CARBO) given at 1.5 g/m2 each with haematopoietic rescue. PBPC were collected after CY administration. Twenty-two patients (88%) completed the HDT, haematological reconstitution was rapid and complete at each step and there were no toxic deaths. The activity of the treatment was high with a CR rate over 90% in the entire patient population. The 2-year overall survival (OS) and failure-free survival (FFS) rates of patients in both Age-Adjusted International Prognostic Index (A-AIPI) groups 2 and 3 are 79% and the disease-free survival (DFS) rate for the CRs is 85%. In A-AIPI group 1 the 2-year OS and FFS rates are both 91%.