High-dose cyclophosphamide followed by autografting can improve the outcome of relapsed or resistant non-Hodgkin's lymphomas with involved or hypoplastic bone marrow

Gino Santini, Carmino De Souza, Angela Marina Congiu, Sandro Nati, Gennaro Marino, Monica Soracco, Mario Roberto Sertoli, Alessandra Rubagotti, Mauro Spriano, Franca Vassallo, Edoardo Rossi, Renato Vimercati, Giovanna Piaggio, Osvaldo Figari, Federica Benvenuto, Monica Abate, Mauro Truini, Jean Louis Ravetti, Iole Ribizzi, Eugenio Damasio

Research output: Contribution to journalArticlepeer-review

Abstract

We report our experience of high-dose cyclophosphamide (HDCY) followed by high-dose therapy (HDT) and peripheral blood progenitor cell (PBPC) autografting in patients with diffuse, intermediate and high-grade non-Hodgkin's lymphomas who have failed conventional treatment. From 1991 to 1996, 54 consecutive patients pre-treated with a median of two chemotherapy lines entered the study. Eighteen patients (33%) were still responders to conventional chemotherapy (sensitive relapse), and 20 patients (37%) were in partial response (PR) after chemotherapy (CT). Sixteen patients (30%) were resistant to conventional CT either at presentation (non responder) or in relapse (resistant relapse). Thirty-nine patients had bone marrow involved by disease and fifteen had an hypoplastic marrow following conventional treatment. Patients received HDCY (7 gr/m2) and G-CSF or GM-CSF in order to collect PBPC. Median collected CD34+ cells was 12.3 x 106/Kg (range 0.7-197). After HDT (BEAM or Melphalan + TBI) 50 patients underwent PBPC autografting. According to intention to treat, 44 (81%) of 54 patients achieved complete remission (CR) (50% after HDCY and 31% after HDT). Procedure related death occurred in 6 patients (11%), one after HDCY and 5 after autografting. Twenty-nine (66%) of 44 patients are still in CR, 7 to 63 months (median 27 months) after the procedure. Three-year probability of survival, disease-free survival and progression-free survival are 63%, 64% and 52% respectively. In conclusion, HDCY is an effective procedure not only in mobilizing PBPC, but also in reducing tumour burden. HDT with PBPC support may further improve the outcome in this category of high-risk non-Hodgkin's lymphomas.

Original languageEnglish
Pages (from-to)321-330
Number of pages10
JournalLeukemia and Lymphoma
Volume33
Issue number3-4
Publication statusPublished - 1999

Keywords

  • High-dose cyclophosphamide
  • Non-Hodgkin's lymphoma
  • PBPC autografting

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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