Autologous stem cell transplantation for non-Hodgkin's lymphoma: comparison of radiation-based and chemotherapy-only preparative regimens.

Abstract

The aim of this study was to compare toxicity and efficacy of total body irradiation (TBI), cyclophosphamide (CY) and etoposide (E) (TBI/CY/E) vs busulfan, melphalan and thiotepa (Bu/Mel/T) in patients receiving autologous stem cell infusion (ASCI) for malignant lymphoma (NHL). Between September 1990 and July 1998, 351 patients with NHL were treated with TBI/CY/E (n = 221) or Bu/Mel/T (n = 130) followed by ASCI. Patients in first, or second remission, first responding or untreated relapse were defined as having less advanced disease before transplantation. The median follow-up was 5 years (range 1-9) and 3.5 years (1-6) for patients receiving TBI/CY/E and Bu/Mel/T, respectively. The cumulative probabilities of survival, event-free survival (EFS) and relapse at 5 years were 44%, 32%, 49% following TBI/CY/E and 42%, 34% and 42% following Bu/Mel/T. The probability of EFS at 5 years for patients who had prior dose-limiting radiation (n = 59) was 32% after Bu/Mel/T therapy. Transplant-related mortality was 16% for TBI/CY/E and 21% for Bu/Mel/T. In univariate and multivariate analyses, more advanced disease status was associated with poor outcome (TBI/CY/E: RR 0.70, CI 0.50 to 0.97 P = 0.04; Bu/Mel/T: RR 0.61, CI 0.39 to 0.97 P = 0.03). No significant differences in toxicities and outcomes were observed between these two regimens despite the inclusion of patients who had received dose-limiting irradiation in the Bu/Mel/T regimen.

• Authors: F Gutierrez-Delgado, D G Maloney, O W Press, J Golden, L A Holmberg, R T Maziarz, H Hooper, C D Buckner, F R Appelbaum, W I Bensinger
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 28 Issue 5 Pg. 455-61 (Sep 2001) ISSN: 0268-3369 [Print] England
• PMID: 11593318 (Publication Type: Clinical Trial, Clinical Trial, Phase II, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Combined Modality Therapy (adverse effects, methods)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects, mortality)
• Humans
• Lymphoma, Non-Hodgkin (mortality, pathology, therapy)
• Male
• Middle Aged
• Prognosis
• Radiotherapy Dosage
• Survival Rate
• Transplantation Conditioning (methods)
• Transplantation, Autologous
• Whole-Body Irradiation (adverse effects, methods)