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Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma.

Publication ,  Journal Article
Horning, SJ; Negrin, RS; Chao, JC; Long, GD; Hoppe, RT; Blume, KG
Published in: J Clin Oncol
December 1994

PURPOSE: High-dose etoposide was incorporated into a regimen of fractionated total-body irradiation (FTBI) and high-dose cyclophosphamide before autologous transplant with the goal to enhance the antitumor effect of the myeloablative regimen in poor-risk lymphoid malignancies. PATIENTS AND METHODS: Ninety-six patients, 24 with recurrent or refractory Hodgkin's disease and 72 with poor-risk non-Hodgkin's lymphoma (NHL), were treated on this study. Cytoreduction with conventional therapy was attempted before administration of the preparatory regimen. The preparatory regimen consisted of 12 Gy total-body irradiation administered in 10 1.2-Gy fractions on day -8 through day -5, etoposide 60 mg/kg on day -4, and cyclophosphamide 100 mg/kg on day -2. Patients with NHL received bone marrow purged with a panel of monoclonal antibodies and complement on day 0, while patients with Hodgkin's disease received peripheral-blood stem cells alone or with unmanipulated bone marrow. RESULTS: The major morbidities of transplant were mucositis and skin toxicity. Eight patients (8.6%) died of regimen-related toxicities within 100 days of transplant. Engraftment was related to the rescue product; the median time to a neutrophil count more than 500/microL was 10 days for patients with Hodgkin's disease and 16 days for NHL patients. With a maximum follow-up duration of longer than 5 years, the 3-year actuarial survival rate is 57%. At 3 years, the actuarial freedom from progression (FFP) rate is 55% and the event-free survival rate is 47% for patients with Hodgkin's disease, while the respective figures for NHL patients are 60% and 53%. Among 32 patients with intermediate- and high-grade lymphoma transplanted subsequent to first relapse, 70% are free of lymphoma and 60% are event-free at > or = 3 years. CONCLUSION: The preparatory regimen consisting of FTBI, etoposide, and cyclophosphamide demonstrates relative efficacy in patients with Hodgkin's disease and NHL selected for high-dose therapy. Longer follow-up duration is needed to determine the rate of cure and to assess late complications. Major remaining challenges for high-dose therapy are a more inclusive strategy for all poor-risk patients and the need to reduce posttransplant relapses.

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Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

December 1994

Volume

12

Issue

12

Start / End Page

2552 / 2558

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Treatment Outcome
  • Transplantation, Autologous
  • Recurrence
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphoma, Non-Hodgkin
  • Humans
 

Citation

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ICMJE
MLA
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Horning, S. J., Negrin, R. S., Chao, J. C., Long, G. D., Hoppe, R. T., & Blume, K. G. (1994). Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma. J Clin Oncol, 12(12), 2552–2558. https://doi.org/10.1200/JCO.1994.12.12.2552
Horning, S. J., R. S. Negrin, J. C. Chao, G. D. Long, R. T. Hoppe, and K. G. Blume. “Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma.J Clin Oncol 12, no. 12 (December 1994): 2552–58. https://doi.org/10.1200/JCO.1994.12.12.2552.
Horning SJ, Negrin RS, Chao JC, Long GD, Hoppe RT, Blume KG. Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma. J Clin Oncol. 1994 Dec;12(12):2552–8.
Horning, S. J., et al. “Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma.J Clin Oncol, vol. 12, no. 12, Dec. 1994, pp. 2552–58. Pubmed, doi:10.1200/JCO.1994.12.12.2552.
Horning SJ, Negrin RS, Chao JC, Long GD, Hoppe RT, Blume KG. Fractionated total-body irradiation, etoposide, and cyclophosphamide plus autografting in Hodgkin's disease and non-Hodgkin's lymphoma. J Clin Oncol. 1994 Dec;12(12):2552–2558.

Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

December 1994

Volume

12

Issue

12

Start / End Page

2552 / 2558

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Treatment Outcome
  • Transplantation, Autologous
  • Recurrence
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphoma, Non-Hodgkin
  • Humans