High dose chemotherapy and autologous bone marrow transplantation in acute leukemias, malignant lymphomas and solid tumors. A study of 23 patients

High-dose chemoradiotherapy and bone marrow transplantation in patients with refractory lymphoma

Eight adult patients with refractory Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) were treated with high-dose combination chemotherapy (cyclophosphamide, BCNU and VP-16) or with cyclophosphamide and fractionated whole-body irradiation (TBI), followed by bone marrow transplant (BMT). Six patients received autologous and two patients allogeneic BMT. Five patients achieved complete remissions, and three of them (two with undifferentiated lymphoma, one with lymphoblastic lymphoma) are alive and free of disease 4-18+ months after BMT. The other two complete responders died of opportunistic infections 2 and 5 months, respectively, after BMT. One patient with HD achieved partial remission and is alive 18+ months after BMT. Two patients were considered failures: one developed leptomeningeal disease 24 days after BMT, and the other died of progressive lymphoma 7 months after BMT. Engraftment and prompt hematologic recovery occurred in all patients. The major toxicity included two fatal infections and one case of diffuse idiopathic interstitial pneumonitis. High-dose chemotherapy with or without TBI followed by BMT appears to produce a high response rate and, although associated with toxicity, it demonstrates the potential for salvaging patients with refractory lymphoma who otherwise would have a dismal prognosis.

Treatment of non-Hodgkin's lymphoma with chemoradiotherapy and allogenic marrow transplantation

Twenty patients with disseminated non-Hodgkin's lymphoma who failed conventional combination chemotherapy were treated with high-dose chemoradiotherapy and marrow transplantation from an HLA-identical sibling. Four patients remain alive in complete remission from 153 to 784 days after transplant. The reason for failure in eight cases was persistence or relapse of lymphoma. In the other eight cases, death was due to a complication of the transplant procedure including interstitial pneumonia, veno-occlusive disease of the liver, graft-versus-host disease, or infection. These results appear similar to those previously observed in patients with acute leukemia in relapse in that a small but significant proportion of patients with otherwise end-stage disease may achieve prolonged complete remission after intensive chemoradiotherapy and allogeneic marrow transplantation.

Intensive chemotherapy for solid tumours--current clinical applications

The treatment of solid tumours with high-dose chemotherapy using alkylating agents either as single agents or in combination schedules has received increasing attention from clinical investigators in recent years. This has frequently been given in association with autologous bone marrow support, a technique which appears to ameliorate myelosuppression that might otherwise be dose-limiting, and which thus may allow dose escalation into a range previously not reached. Despite this ability, and in spite of much experimental evidence from drug-sensitive animal tumours that increasing doses result in increased response rates, no major impact has yet been made in the therapy of solid tumours using this form of therapy. In addition, the use of high-dose schedules has seen the emergence of extramedullary manifestations of drug toxicity which were not encountered at conventional doses. Nevertheless, there are some encouraging data from reports in certain tumours, including small cell lung cancer, testicular cancer, ovarian cancer, and lymphoma, and further studies are clearly indicated. These should probably be restricted to certain drug-sensitive tumours, and should include an examination of the role of high-dose chemotherapy as consolidation treatment, following conventional induction therapy for selected tumour types. This form of treatment may yet provide an important contribution to the control of human solid tumours, but much further work, probably with combination drug schedules, is required.