engleski

Autologous stem cell transplantation in patients with aggressive non-Hodgkin's lymphoma

Introduction: A significant proportion of patients with aggressive non Hodgkin's lymphomas (NHL) either do not achieve remission after initial treatment or relapse later during the course of the disease. We present our 7-years' experience in the treatment of these patients with intensive chemotherapy followed by autologous stem cell transplantation (ASCT). Objectives: To evaluate ASCT in this subset of patients by assessing its: 1) toxicity, in terms of transplant related mortality (TRM), hematopoietic recovery and need for transfusion support. 2) efficacy, in terms of CR, PR and NR achieved, and long term efficacy expressed as both disease free (DFS) and overall survival (OS). Patients and methods: From November 1993 until November 2000 a total of 48 patients with aggressive NHL, including 2 in leukemic phase of lymphoblastic lymphoma (27 male, 21 female ; age 18-67, median 40), received BEAM myeloablative treatment followed by ASCT. Two patients were transplanted in CR, all others had active disease at time of transplantation. All patients received heavy prior treatment with a median of 2 different lines of chemotherapy (range 1-5) and a median of 8 chemotherapeutic cycles (range 4-31). An average of 9.28 (range 1.13-59.2, SD 11.9) x 106/kg CD34+ cells was reinfused and G-CSF (5 micrograms/kg) was administered during the leukopenic period to all but one patient (median 9 days). Results: Median time to WBC recovery (>1x109/L) was 10 days (range 6-19), while platelets recovered (>20x109/L) in a median of 12 days (range 6-26). An average of 16.8 platelet doses (range 0-62, SD 12.4) and 568.8 mL of RBC concentrate (range 0- 4080, SD 796.1) was administered. A median of 4 febrile days (range 0-12) was observed. Of all patients, 28 achieved CR (58.3%) and 16 achieved PR (33.3%). Three patients died during the pancytopenic period (TRM 6.3%). At 7 years from transplantation, projected OS is 51.5% while DFS is 42.1% (median 64 months). Younger patients (£ ; ; ; 35 years) have a significantly higher OS (82.5%, p=0.01) and DFS (68.2%, p=0.004). Conclusions: Given that all patients received heavy prior treatment and had active disease at time of transplantation, ASCT toxicity can be considered as acceptable. A high remission rate was achieved (CR+PR 91.6%). DFS of 42.1% at 7 years in this group of patients is highly satisfactory. We conclude that ASCT is a very effective treatment for patients with aggressive NHL. Younger patients are particularly likely to benefit from this treatment procedure.

Autologous stem cell transplantation; malignant lymphomas

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