Augmented Preparative Regimens Using Total Body Irradiation or BCNU Prior to Autologous Stem Cell Transplant (AuSCT) Are Well-Tolerated and Yield Substantial Rates of Progression-Free Survival in Patients with Poor Risk Hodgkin Lymphoma (HL) or Diffuse Large B-Cell Lymphoma (DLBCL).

Introduction: AuSCT using conditioning such as BEAM, for relapsed DLBCL and HL results in progression-free survival (PFS) of 60% of cases in second complete remission (CR). Those who do not achieve a second CR or who have primary refractory disease have significantly reduced benefit from BEAM/AuSCT. Consequently, we have been offering dose intensified conditioning prior to AuSCT with the Stanford regimen using Etoposide 60mg/kg day-4, Cyclophosphamide 100mg/kg day-2 and either BCNU 15mg/kg day-6 or fractionated TBI 12Gy days-8 to -5 to patients with poor risk haematologic malignancy.

Methods: We assessed the outcome of AuSCT in 46 patients with poor risk haematologic disease; DLBCL (n=16), HL (n=16), multiply relapsed indolent lymphoma (n=8) and aggressive “other” lymphomas (n=6) who received conditioning with either the BNCU (n=31) or TBI (n=15) protocols. Of the 32 patients with HL or DLBCL, 28 had previously failed to achieve a CR to salvage chemotherapy; PR (21/32) or induction failure/early progression (7/32).

Results: There were no transplant-related deaths among the 32 HL or DLBCL patients. One case of fatal radiation pneumonitis occurred following consolidative radiotherapy 6 months post AuSCT. The PFS for the combined HL/DLBCL cohort was 65±9% at 12, and 61±9% at 24 months. The 24 month PFS by BCNU or TBI regimen was 63% and 57% respectively (p=0.56). The 24 month PFS for HL or DLBCL treated with either regimen was 54±13% and 68±12% respectively (P=0.34) Additional groups were too heterogeneous to statistically assess. 1 of 6 patients with aggressive “other” lymphoma maintained a durable remission (39 months) and 4/8 patients with indolent lymphoma have ongoing CR at 9 – 59 months follow up.

Conclusions: Stanford TBI or BCNU conditioning prior to AuSCT are well-tolerated and result in substantial rates of PFS in patients with poor risk HL or DLBCL.