Cancer Res Treat.  2007 Jun;39(2):54-60.

Autologous Stem Cell Transplantation using a Modified TAM Conditioning Regimen for Clinically Aggressive Non-Hodgkin's Lymphoma

• Hong SH
• Hong YS
• Woo IS
• Koh YH
• Rho SY
• Peak JY
• Lee MA
• Shim BY
• Byun JH
• Park JC
• Lee JW
• Min WS
• Kim CC

Abstract

PURPOSE: High-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) have been used for the treatment of clinically aggressive non-Hodgkin's lymphoma (NHL). However, the superiority of specific conditioning regimens has not yet been established. The present study evaluated the efficacy and toxicity of a conditioning regimen involving fractionated total body irradiation (TBI), and the use of Ara-C and melphalan (TAM) for clinically aggressive NHL.
MATERIALS AND METHODS
Between March 2002 and December 2004, 31 patients with aggressive NHL received fractionated TBI with a dose of 12 Gy over 3 days, and were administered 9 g/m2 Ara-C and 100 mg/m2 melphalan followed by autologous peripheral blood stem Cell Transplantation at the Catholic Hematopoietic Stem cell transplantation Center Korea. Patients that responded to first line chemotherapy and achieved complete remission (CR), or were in a first sensitive relapse were defined as having less advanced disease, while the other patients were defined as having more advanced disease.
RESULTS
Objective responses were obtained in 24 of 31 patients (77.4%), comprising complete remission in 19 patients (61.3%) and partial remission in 5 (16.1%) patients. The median follow-up time was 28 months (range 1~62 months). At 3 years, the overall survival and event-free survival (EFS) rates were 62.3% and 47.3%, respectively. Patients with less advanced disease and more advanced disease showed 3-year EFS rates of 73.3% and 22.5 %, respectively (p=0.006). Early (within the first 100 days) treatment-related mortality occurred in 3 (9.7%) patients. Of the 31 total patients, 15 (48.4%) developed grade 3 mucositis, 22 (70.9%) developed neutropenic fever, and two (6.5%) developed interstitial pneumonia syndrome >grade 3.
CONCLUSION
The modified TAM conditioning regimen and ASCT appear to be a feasible treatment regimen for clinically aggressive NHL, particularly for patients with less advanced disease.

Keyword

TAM conditioning; High dose therapy; Autologous stem cell transplantation; Non-Hodgkin's lymphoma

MeSH Terms

Cytarabine
Disease-Free Survival
Drug Therapy
Fever
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Humans
Korea
Lung Diseases, Interstitial
Lymphoma, Non-Hodgkin*
Melphalan
Mortality
Mucositis
Peripheral Blood Stem Cell Transplantation
Recurrence
Stem Cell Transplantation*
Stem Cells*
Whole-Body Irradiation
Cytarabine
Melphalan

Figure

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  Fig. 1 Overall survival of 31 patients as determined by the Kaplan-Meier method.

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  Fig. 2 Event free survival of 31 patients as determined by the Kaplan-Meier method.

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  Fig. 3 Event free survival according to the disease status.

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