The majority of poor-risk lymphoma patients are not cured with conventional chemotherapy. There is evidence for superiority of single high-dose chemotherapy in such patients, but many still die from recurrent disease. Strategies to improve survival in these poor-risk patients include dose-intensification with high-dose chemotherapy and PBSC support autologous transplantation. These more aggressive strategies are feasible and tolerable. Whether tandem transplantation will prove more effective than current single high-dose therapy in appropriately selected patients remains to be determined. The purpose of this study was to evaluate the effectivity and safety of mobilization regimen, and the effectivity and tolerance of sequential chemotherapy combined with tandem autotransplant in aggressive lymphoma. In this study, the clinical data of 5 patients with recurrent, aggressive lymphoma treated with of sequential chemotherapy combined with tandem autotransplant were analysed respectively. The group included 1 HD and 4 NHL. Mobilization regimen was CHOEP combined with G-CSF (5ug•kg−1•d−1). The conditioning regimen for the tandem transplantation was high-dose CHEOP. The interval of the two autotransplantation was 9(5~31)weeks. In tandem autotransplant, the cell number of MNC which was transfused was 3.05 (ranged from 1.91~4.14) ×108 •kg−1 and 3.55 (ranged from 2.23~6.0) ×108•kg−1; CD34+ was 4.11 (ranged from 2.59~4.94) ×106•kg−1 and 5.70 (ranged from 2.77~10.6) ×106•kg−1; CFU-GM was 2.96 (ranged from 2.01~4.54) ×105•kg−1 and 2.44 (ranged from 1.78~2.9) ×105•kg−1 respectively (P>0.05). All patients reached prompt and sustained hemotopoietic reconstitution. The interval of ANC ≥0.5×109/L was 10 days (ranged from 8~12) and 10.5 days (ranged from 9~12); Pt ≥2.0×109/L was 11 days (ranged from 10~14) and 12.5 days (ranged from 10~15) respectively (P>0.05). Four patients were alive while 3 was in disease-free with median 46 (range 9~88) months. The overall survival was 80%, and the disease-free survival was 60%. In the conclusion, the method of sequential high-dose CHEOP chemotherapy combined with tandem autotransplant of peripheral blood stem cells for aggressive lymphoma is safe and effective.

Topics:
chemotherapy regimen, non-hodgkin's lymphoma, aggressive, peripheral blood stem cells, transplantation, autologous, transplantation, death, granulocyte colony-stimulating factor, lymphoma, recombinant granulocyte colony stimulating factor, cell count

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2005, The American Society of Hematology
2005
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