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Patterns of recurrence after high-dose chemotherapy with autologous stem cell transplantation for refractory lymphoma.

6659 Background: High-dose therapy (HDT) with or without total body irradiation followed by autologous stem cell transplantation (ASCT) is a therapeutic option for patients with relapsed or refractory to initial treatment for lymphoma. However, there are relatively few reports regarding outcome following recurrence after HDT therapy. In order to investigate outcome of the HDT, the patterns of recurrence and survival were analyzed.


METHODS
A total of 61 patients were treated with HDT followed by ASCT between Feb. 1991 and Dec. 2001. In this study, we investigated patterns of relapse and the factor especially bone marrow involvement at time of diagnosis.


RESULTS
Fifty-four patients were aggressive lymphoma, 4 were high-grade lymphoma, and 3 were low-grade lymphoma. Involved-field radiotherapy was added to sites of disease, if the sites were indicated after HDT. Median length of follow-up was 70 (24-156) months. Fifty-nine patients were assessable. Forty nine of 59 (83%) patients had complete response or continued CR, and 25 of 49 (51%) patients relapsed at median time of 20.5 (1.4-124.9) months after ASCT. Twelve of 25 patients (48%) relapsed 2 years after HDT. Seventeen of 25 patients (68%) presented with recurrence at previous sites of disease, five patients (20%) at new sites, and three patients (12%) at both previous and new sites. The length of 50% survival of the relapsed patients was 20.7 months. The Kaplan-Meier estimate of patients alive 5 years after recurrence was 13%. We analyzed relapse pattern according to bone marrow involvement. The results were shown in the table. [Figure: see text] The relapse patterns and survival after HDT followed by ASCT were identical in both groups.


CONCLUSIONS
The HDT followed by ASCT might be able to save some group of refractory lymphoma patients regardless of bone marrow involvement. No significant financial relationships to disclose.