Treatment of refractory lymphoma with high dose cytarabine, cyclophosphamide and either TBI or VP-16 followed by autologous bone marrow transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 5; no. 5; pp. 341 - 344
• Main Authors: BROUN, E. R, TRICOT, G, AKARD, L, NICHOLS, C, CHEERVA, A, JANSEN, J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.05.1990
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation; Combined Modality Therapy - adverse effects; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Etoposide - administration & dosage; Female; Hodgkin Disease - mortality; Hodgkin Disease - therapy; Humans; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Survival Rate; Whole-Body Irradiation; Human; Antineoplastic agent; Toxicity; Hodgkin disease; Malignant hemopathy; Malignant tumor; Non Hodgkin lymphoma; Radiotherapy; Autograft; Chemotherapy; Polychemotherapy; Treatment; Lymphoproliferative syndrome; Bone marrow; Adult; Graft; Tumor; Whole body; Negative therapeutic reaction
• ISSN: 0268-3369; 1476-5365

This study was designed to test the efficacy and toxicity of combining high-dose cytarabine (3 g/m2 every 12 h x 8 doses day -7 to day -4, total dose 24 g/m2), methyl prednisolone (0.5 mg/kg every 4 h day -7 to day -1), and cyclophosphamide (CY) (60 mg/kg day -3 and day -2) with either total body irradiation (TBI) (900 cGy in a single fraction on day -1) or VP-16 (600 mg/m2/days -7, -5, and -3) in patients not eligible for TBI secondary to prior radiotherapy. We treated 14 patients (eight male, six female) with either non-Hodgkin's lymphoma (n = 5) or Hodgkin's disease (n = 9). All patients had failed prior conventional chemotherapy (median two regimens range 1-5). Five patients were treated with TBI and nine with VP-16. There were eight complete remissions, two partial remissions, four were inevaluable for response due to early death. Overall survival is 21% (3/14) and relapse-free survival is 7% (1/14) with the sole disease-free survivor now 40 months from transplant. Very significantly, among patients receiving TBI, there were no survivors (median survival 24 days, range 17-330 days) and 4/5 had pulmonary complications. Median DLCO in these four patients was 61% (range 50-67) prior to transplant and none had an infectious etiology established by bronchoalveolar lavage. Median time to an absolute granulocyte count of 500 x 10(6)/l was 16 days (range 10-37 days) and to a platelet count of 20 x 10(9)/l was 12 days (range 7-22 days). In conclusion, the addition of high-dose cytarabine (24 g/m2) to CY and single-dose TBI or VP-16, while being very active, produced excessive pulmonary toxicity in this group of patients with lymphoma.