HIGH DOSE CHEMOTHERAPY AND AUTOLOGOUS PERIPHERAL STEM CELL TRANSPLANTATION IN RELAPSING AGGRESSIVE NON HODGKIN'S LYMPHOMA

Abstract

Introduction: Relapsing aggressive Non Hodgkin's Lymphoma (NHL) is considered one of the major challenges in the field of oncology. With the use of conventional salvage regimens, only 30-40% of patients attain long term disease-free survival. The application of high-dose chemotherapy (HOC) and autologous peripheral stem cell transplantation (PSCT) was attempted to improve the outcome of this group of patients. Patients & Methods: The current study included 15 patients with relapsing aggressive NHL. Disease responsiveness was initially assessed by 2 cycles of the DHAP salvage chemotherapy protocol. Five patients were excluded either due to lack of disease responsiveness (2 patients) or grade III renal toxicity (2 patients) or both ( l patient). The remaining 10 patients were admitted to the study arms with 4 patients in the HOC and PSCT arm and 6 patients in the conventional salvage DHAP arm. Results: Disease status was assessed in all patients at the end oftreatment. In the HOC arm, 2 patients achieved complete remission (CR), one patient attained major partial remission (MPR) and one patient died during the transplantation procedure. In the DHAP arm, four patients achieved CR, 2 patients suffered disease progression (DP) with one patient from the later group died at the end of salvage. After a median follow up of 6 months (6-19), all patients in the HOC arm relapsed after a median of 6 months (range 6-19) and 2 patients in the DHAP arm relapsed after 2 and 6 months from the end of salvage. The average cost of the HOC and PSCT procedure was 47,206 L.E. and for full course ofDHAP (median of5 cycles, including supportive care) it was 15,858 L.E. Conclusion: HOC & PSCT is a tolerable procedure with proper supportive care. Future HOC studies should include a larger number of patients before statistically significant results can be obtained. Cost reduction can be achieved through the utilization of conventional salvage regimens in mobilizing stem cells which, the delayed administration of hematopoietic growth factors in the post­ reinfusion period, and the utilization of outpatient procedures during some of the transplantation steps.