High‐dose cyclophosphamide, etoposide and BCNU (CVB) with autologous stem cell rescue in malignant lymphomas

Abstract

Eighteen patients with malignant lymphoma, 10 non‐Hodgkin's and 8 Hodgkin's, were treated with high‐dose CVB (cyclophosphamide 4 × 1.5 g/m2, etoposide 4 × 250–400 mg/m2, carmustine 4 × 150–200 mg/m2), followed by autologous peripheral blood stem cells (PBSC, 13 patients) or bone marrow (BM, 5 patients) transplantation. At the time of autograft 6 patients were in complete remission (CR), 3 in partial remission (PR) and 5 in relapse (4 sensitive, 1 resistant), whereas 4 had progressive disease. All CR patients had poor prognostic features at presentation. PBSC were collected at the time of rapid hematologic recovery after intense chemotherapy by means of a cell separator. All patients engrafted. Median time to achieve ≥0.5 × 109/1 polymorphonuclear cells (PMN) and ≥50 × 109/1 platelets was 13 days for both cell types in PBSC autografted patients, versus 20 and 28 days respectively in BM autografted patients. A significant advantage of PBSC over BM was found in terms of time needed to recover either PMN ≥0.5 and PMN≥1 × 109/1 (p = 0.01). Autograft‐related toxicity consisted mainly of moderate severity interstitial pneumopathy (3 patients), and veno‐occlusive disease (1 patient) that resolved completely. Of the 12 patients autografted with detectable disease, 6 (50%) obtained a CR. Seven out of 18 autografted patients (39%) had disease progression within 1 to 5 months of autograft. The projected progression‐free survival is over 50% at 4 years and it was significantly longer in patients with sensitive disease than in those with resistant disease (p = 0.01). The efficacy and the low toxicity of CVB suggest that autograft with PBSC may be proposed for the primary treatment of poor prognosis malignant lymphomas.

Lymphomas

“…The most commonly used conditioning regimens are BEAM (BCNU, etoposide, cytarabine, melphalan) and CVB/CEB (cyclophosphamide, etoposide, BCNU), although no regimen has been demonstrated to have superior remission rates or long-term outcomes (Caballero et al 1997 ;Argiris et al 2000 ;Patti et al 1993 ;Reece et al 1991 ). Randomized trials are lacking.…”

Safety and efficacy of high-dose ranimustine, cytarabine, etoposide and CY (MCVAC) regimen followed by autologous peripheral blood stem cell transplantation for high-risk diffuse large B-cell lymphoma

“…Pulmonary toxicity has been well recognized as a complication related to the use of BCNU-containing regimens. The incidence of non-infectious pulmonary complications associated with BCNU-containing conditioning regimens for autologous hematopoietic SCT such as interstitial pneumonitis has been reported to be 11-26% (Patti et al, 24 Mills et al, 25 Stiff et al, 26 Alessandrino et al…”