High Dose Chemotherapy with Autologous Stem Cell Transplantation in Malignant Lymphoma - A Single Center Experience.

Introduction

High-dose chemotherapy with autologous stem cell transplantation plays an important role in the treatment of malignant lymphoma. Here, we report on a retrospective analysis of the data of 52 patients with malignant lymphoma who were consecutively treated with high-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) at the University Hospital of Bonn, Germany, between 1996 and 2004.

Patients and methods

A total of 52 consecutive patients were transplanted. Forty patients (76.9%) had aggressive non-Hodgkin’s lymphoma, 5 (9.6%) had indolent non-Hodgkin’s lymphoma, and 7 (13.5%) had Hodgkin’s disease. Thirty-two (61.5%) patients were treated with HDT and ASCT as first-line therapy. Of these, 15 patients received up-front chemotherapy due to the presence of > 2 adverse prognostic factors according to the international prognostic index, 12 patients received high-dose chemotherapy due to incomplete response to standard induction chemotherapy and five patients were treated for primary refractory disease. Twenty (38.5%) patients had recurrent lymphoma. Chemosensitive relapse was present in 17 patients whereas three patients were treated for chemoresistant disease. The conditioning regimen was BEAM in 19 (36.5%), Mega-CHOEP in 16 (30.8%), CEIAP in 6 (11.5%), CEI in 5 (9.6%), and cyclophosphamide/ total body irradiation in 3 (5.8%) patients, respectively. Other regimens were used in 3 patients (5.7%).

Results

A complete remission was achieved in 35 of 52 patients (67.3%). At a median follow-up duration of 39.7 months (range 10–110), estimated 3-year overall survival was 55.8% and 3-year progression free survival was 47.8%. Median overall survival was 63.6 months, and median progression-free survival was 23.4 months. There were 6 (11.5%) deaths due to treatment-related toxicity within the first 50 days after transplantation. Five of these patients had relapsed disease and one had primary refractory disease. Median overall survival was 63.6 months in the primary high-risk group (n=15). Median overall survival in patients treated for incomplete response to first-line chemotherapy or chemosensitive relapse (n=12 and n=17, respectively) has not been reached yet; the mean overall survival in these subgroups was 67.7 and 57.2 months, respectively. Median overall survival was 5.5 months in the chemoresistant relapse group (n=3), and 6.8 months in the primary refractory group (n=5), respectively. Pre-transplantation disease status was the most important prognostic factor in determining overall survival and progression-free survival.

Conclusions

Our results confirm that HDT and ASCT is a highly effective therapy in patients with malignant lymphoma. Patients with primary high-risk disease, incomplete response to conventional first-line therapy or with sensitive relapse have a good prognosis, while primary refractory and patients with resistant relapse do not benefit from HDT with ASCT.