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High-dose chemoradiotherapy followed by autologous bone marrow
transplantation as consolidation therapy during first complete remission in
adult patients with poor-risk aggressive lymphoma: a pilot study [see
comments]
A Nademanee, GM Schmidt, MR O'Donnell, DS Snyder, PA Parker, A Stein, E Smith, JA Lipsett, I Sniecinski and K Margolin
Department of Hematology and Bone Marrow Transplantation, City of Hope
National Medical Center, Duarte 91010.
Twenty consecutive patients with poor-risk aggressive lymphoma who at
presentation either had elevated serum lactic dehydrogenase level (LDH) and
any one of the other poor-prognostic features: bulky mass greater than or
equal to 10 cm, advanced stage III or IV, and greater than or equal to 2
extranodal sites, or normal LDH level and all other three features,
underwent high-dose chemo/radiotherapy followed by unmanipulated autologous
bone marrow transplantation (BMT) during their first complete remission.
Eighteen had B-cell lymphoma and 2 had T-cell lymphoma. Eleven patients had
high-grade (7 immunoblastic, 3 small noncleaved, non-Burkitt's, and 1
Burkitt's) and 9 had diffuse large cell lymphoma. All patients had achieved
a complete remission following conventional chemotherapy. Four patients had
also received involved field radiotherapy to areas of bulky disease. The
preparative regimen consisted of high-dose etoposide 60 mg/kg and
cyclophosphamide 100 mg/kg in combination with fractionated total body
irradiation (FTBI) 1,200 cGy (15 patients), or single-dose TBI 750 cGy (2
patients), or carmustine 450 mg/m2 (3 patients). All patients tolerated the
treatment well and achieved complete hematologic recovery. Three patients
have relapsed at days 79, 196, and 401 after transplantation. Seventeen
patients (84%) are alive and relapse-free with a median follow-up of 34
months (range 2 to 54). We conclude that high-dose chemo/radiotherapy
followed by autologous BMT can be given as consolidation therapy during
first remission in these patients with minimal transplant-related toxicity.
Volume 80,
Issue 5,
pp. 1130-1134,
09/01/1992
Copyright © 1992 by The American Society of Hematology
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