Pilot study of tandem high-dose chemotherapy and autologous stem cell transplantation with a novel combination of regimens in patients with poor risk lymphoma

bIn an effort to improve the outcome of poor-risk lymphoma patients, we evaluated a novel regimen of tandem high-dose chemotherapy(THDC) with autologous stem cell transplantation. A total of 41 patients ( median age 40 years, range 15-68 years) with poor-risk non-Hodgkin's lymphoma and Hodgkin's disease were enrolled. THDC consisted of melphalan ( 180 mg/m(2)) and escalating dose mitoxantrone (30-50 mg/m(2)) (MMt) for the. first conditioning regimen, and thiotepa ( 500 mg/m(2)), carboplatin ( 800 mg/m(2)), and escalating dose etoposide phosphate (400-850 mg/m(2)), (ETCb) as the second regimen. In all, 31 patients ( 76%) completed both transplants, with a median time between transplants of 55 days ( range 26-120). The maximum tolerated dose was determined as 40 mg/m2 for mitoxantrone and 550 mg/m(2) for etoposide phosphate. The overall toxic death rate was 12%. Following high-dose chemotherapy, 10 of 24 evaluable patients (42%) were in CR. The two-year overall survival and event-free survival is 67% ( 95% CI, 52-81%) and 45%, ( 95% CI, 29-61%) for the 41 patients enrolled; and 69% ( 95% CI, 525-586%) and 48% ( 95% CI, 30-67%) for the 31 patients completing both transplants. This THDC regimen is feasible but with notable toxicity in heavily pretreated patients; its role in the current treatment of high-risk lymphoma remains to be determined.