Journal of Clinical Oncology, Vol 10, 1682-1689, Copyright © 1992 by American Society of Clinical Oncology
High-dose carmustine, etoposide, and cisplatin and autologous bone marrow transplantation for relapsed and refractory lymphoma
HM Lazarus, P Crilley, N Ciobanu, RJ Creger, RM Fox, DC Shina, SI Bulova, R Gucalp, BW Cooper and D Topolsky
Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, OH 44106.
PURPOSE: We determined the toxicity and efficacy of a new preparative
autologous bone marrow transplantation (ABMT) regimen in patients with
relapsed or refractory non-Hodgkin's lymphoma or Hodgkin's disease.
PATIENTS AND METHODS: Forty-four non-Hodgkin's lymphoma and 35 Hodgkin's
disease patients 16 to 63 years of age were given intravenous carmustine
(BCNU) 600 to 1,050 mg/m2, etoposide 2,400 to 3,000 mg/m2, and cisplatin
200 mg/m2 (BEP) and ABMT. Fifty-nine patients also received 15 to 20 Gy
local radiation (involved-field radiotherapy [RI]) to active or previously
bulky (> 5 cm) disease sites. RESULTS: Nonhematologic toxicities
included nausea, vomiting, high-tone hearing loss, stomatitis, esophagitis,
diarrhea, and hepatic and pulmonary toxicity. Two patients died within 40
days of marrow infusion as a result of sepsis and one patient died 7 months
after transplant as a result of pulmonary fibrosis. Complete remissions
(CRs) were noted in 72% (n = 57) of patients (n = 33 non-Hodgkin's
lymphoma; n = 24 Hodgkin's disease). Forty patients (51%) remained alive
and disease- free (n = 24 non-Hodgkin's lymphoma; n = 16 Hodgkin's disease)
at a median of 17 (range, 8 to 57) months after marrow reinfusion.
CONCLUSIONS: This regimen seems to be effective for relapsed lymphoma
patients whose disease continues to exhibit chemotherapy sensitivity (16 of
24 [67%] disease-free). Furthermore, this regimen seems to be effective in
patients who have never attained a CR (seven of 19 [37%] disease-free).
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