Treatment of Resistant Malignant Lymphoma with Cyclophosphamide, Total Body Irradiation, and Transplantation of Cryopreserved Autologous Marrow

• Published in: The New England journal of medicine Vol. 310; no. 24; pp. 1557 - 1561
• Main Authors: Phillips, Gordon L, Herzig, Roger H, Herzig, Geoffrey P, Lazarus, Hillard M, Fay, Joseph W, Wolff, Steven N, Mill, William B, Lin, Hsiu-san, Thomas, Patrick R. M, Glasgow, Glenn P, Shina, Don C
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 14.06.1984
• Subjects: Adolescent; Adult; Aged; Autografts; Biopsy; Blood Cell Count; Bone marrow; Bone Marrow Transplantation; Cancer therapies; Chemotherapy; Child; Child, Preschool; Combined Modality Therapy; Congestive heart failure; Cryopreservation; Cyclophosphamide; Cyclophosphamide - therapeutic use; Drug dosages; Female; Freezing; Hematology; Humans; Leukemia; Leukocytes (neutrophilic); Lymphoma; Lymphoma - mortality; Lymphoma - therapy; Male; Medical prognosis; Middle Aged; Oncology; Patients; Pneumonitis; Preservation, Biological; Radiation; Radiation therapy; Remission; Sepsis; Transplantation; Transplantation, Autologous; Transplants & implants; Whole-Body Irradiation; X-rays
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198406143102403

Twenty-seven patients with malignant lymphoma in whom primary chemotherapy had failed and the prognosis was poor were treated with cyclophosphamide, total body irradiation, and transplantation of cryopreserved autologous marrow. The median time to recovery of more than 500 neutrophils per microliter and more than 10,000 platelets per microliter was 18 and 24 days, respectively. Complete remission was achieved in 15 patients (56 per cent), five of whom were in continuous remission at this writing 19 to 71 months after transplantation without further therapy and one of whom was alive in a subsequent remission at 20 months. Fifteen patients died of lymphoma, three of interstitial pneumonitis, two of sepsis, and one of congestive heart failure. This experience shows that intensive therapy and autologous-marrow transplantation can produce prolonged remissions in patients with malignant lymphoma in whom conventional chemotherapy has failed. (N Engl J Med 1984; 310:1557–61.) COMBINATION chemotherapy produces complete remissions in most patients with disseminated Hodgkin's disease 1 or aggressive non-Hodgkin's lymphoma 2 ; however, patients who do not obtain a remission or who relapse after primary chemotherapy have a poor prognosis. 3 4 5 Intensive therapy with total body irradiation and marrow transplantation can produce prolonged remissions in patients with resistant hematologic cancers. 6 The utility of allogeneic-marrow transplantation is limited by the lack of compatible donors and the complications of graft-versus-host disease. 6 Autologous-marrow transplantation avoids these problems and is potentially available for any patient with normal bone marrow. 7 We report the successful use of the combination of cyclophosphamide, total . . .