One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: Value of pretransplant disease status for predicting outcome

Aaron P. Rapoport, Jacob M. Rowe, Peter A. Kouides, Reggie A. Duerst, Camille N. Abboud, Jane L. Liesveld, Charles H. Packman, Shirley Eberly, Michael Sherman, Martin A. Tanner, Louis S. Constine, John F. DiPersio

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154 Scopus citations

Abstract

Purpose: One hundred autotransplants for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) were examined prospectively to identify variables with prognostic significance. Patients and Methods: Ninety-six patients with relapsed or refractory HD or NHL underwent 100 autotransplants. Patients received high-dose carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem-cell rescue. Results: The 3-year actuarial event-free survival (EFS) rate for the 47 HD patients is 49%, with a median followup duration of 2 years. For the 53 NHL patients, the 3-year actuarial EFS rate is 40%, with a median follow-up duration of 19 months. By multivariate analysis, minimal disease on admission (all areas ≤ 2 cm) is associated with improved EFS (HD, P = .003, NHL, P = .03). The projected EFS rate for HD patients entering with minimal disease is 70% versus 15% for patients with bulky dis-ease (P = .0001). The projected EFS rate for NHL patients with minimal disease is 48% versus 25% for patients with bulky disease (P = .04). Posttransplant involved-field radiotherapy, administered to 26 of the last 61 patients, was associated with an improved EFS rate for NHL patients (P = .015). The BEAC regimen was well tolerated by patients who entered the study with minimal disease (mortality rate, < 5%), but caused significant toxicity in patients with bulky disease (mortality rate, 25%). Conclusion: Disease burden before autotransplantation is an important predictor of regimen-related toxicity and EFS. Posttransplant involved-field radiotherapy may improve outcomes in select patients with NHL. The BEAC regimen is safe and effective, particularly for patients with minimal disease.

Original languageEnglish
Pages (from-to)2351-2361
Number of pages11
JournalJournal of Clinical Oncology
Volume11
Issue number12
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

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    Rapoport, A. P., Rowe, J. M., Kouides, P. A., Duerst, R. A., Abboud, C. N., Liesveld, J. L., Packman, C. H., Eberly, S., Sherman, M., Tanner, M. A., Constine, L. S., & DiPersio, J. F. (1993). One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: Value of pretransplant disease status for predicting outcome. Journal of Clinical Oncology, 11(12), 2351-2361. https://doi.org/10.1200/JCO.1993.11.12.2351