HIGH DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM CELL TRANSPLATATION FOR POOR RISK AAGGRESSIVE NON - HODGKINSKS LYMPHOMA

Abstract

Fewer than 40% of advanced-stage, aggressive NHL patients are cured with CHOP chemotherapy. Accordingly the present study was designed to investigate the feasibility and efficacy of consolidation with high-dose chemotherapy with autologous stem cell support in patients with poor prognosis aggressive NHL who achieve 1st CR. The study included 20 patients with poor risk (high intermediate or high-risk according to the Aa-IPI) aggressive NHL. Sixteen patients achieved CR either with CHOP (14 patients) or with 2nd line salvage chemotherapy (2 patients). Ten of those 16 patients were autotransplanted and the other six patients were excluded due to various causes. The regimen used for mobilization was either the last cycle of CHOP plus G-CSF or high dose cyclophosphamide based regimen plus G-CSF. The mean number of harvested CD34+ve cells per patient was 6.42 X106 cells/kg. The mean number of reinfused CD34+ve cells per patient was 3.94 X106 cells/kg. The high dose ICE regimen (Ifosfamide 10gm/m2, Paraplatin 1200 mg/m2; and Etoposide 1200 mg/m2 divided on 4 days) was used. There was one treatment-related death.The other nine patients engrafted successfully (90%). With a median follow up period of fourteen months, the overall survival rate of the ten autotransplanted patients was 67.5% and the disease free survival rate was 66.7%. Further evaluation of this technique in a randomized trial is warranted.