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

Abstract

Introduction: Relapsing aggressive Non Hodgkin's Lym phoma (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 transpl antation (PSCT) was attempted to improve the outcome of th is 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 (1 patient). The remaining 10 patients were adm itted 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 of treatment. In the HOC arm, 2 patients achieved complete remission (CR), one patient attai ned 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 (6-1 9), all patients i n the HOC arm relapsed after a med ian 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 of DHAP (med ian of 5 cycles, including supportive care) it was 15,858 L.E. Conclusion: HOC & PSCT is a tolerable procedure with proper supporti ve care. Future HOC studies should include a larger n um ber 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 growt h factors in the post­ rein fusion period, a nd the uti l ization of outpatient procedures during some of the transplantation steps.