Letters 858 Eur3 Cancer, Vol. 26, No. 7, p. 858, 1990. Printed in Great Bntatn 0277~S379lW$3.00 + 0.00 0 1990 Pergama Press plc BEAM Protocol and Autologous Bone Marrow Transplantation in First Chemosensitive Relapse of Non- Hodgkin’s Lymphomas Ph. Colombat, P. Biron, J.P. Laporte, J.Y. Cahn, P. Herve, N.C. Gorin, J.P. Lamagnere and Th. Philip for the French Autologous Bone Marrow Transplantation Group PATIENTS WITH intermediate or high grade non-Hodgkin’s Lym- phomas (NHL) who fail on conventional chemotherapy either with primary resistant disease or after relapse are rarely cured by conventional salvage chemotherapy. Since 1978 [l], many reports [2-81 have been published about the efficacy of high- dose chemotherapy with or without total body irradiation and autologous bone marrow transplantation (ABMT). But a wide range of results was observed, with disease-free survival between 15% and 69%. We report long-term results of patients treated in four French ABMT centres between June 1983, and December, 1987. The patients were in first chemosensitive relapse of intermediate or high grade NHL by the BEAM protocol (carmustine, etoposide, cytarabine arabine, melphalan) and ABMT. 19 patients were included in this retrospective study. Age was 7-61 years (median 33). There were 15 men and 4 women. According to the National Cancer Institute Working Formu- lation, there were five mixed diffuse, six diffuse large cell, three immunoblastic, three lymphoblastic, and two Burkitt’s lymphomas. At diagnosis, 10 patients had constitutional symp- toms and 9 had extranodal disease with two or more localisations in 3. At diagnosis 10 patients had bulky disease (defined as a node larger than 10 cm in its greatest diameter, or extensive abdominal disease) and 5 had more than three nodes involved sites. Median duration of the first complete remission was 10 months (range 5-41) with 8 relapses on therapy and 11 off therapy. 8 relapses were localized in nodes, 2 in nodes and bone marrow, 3 were nodal and extranodal and 6 were pure extranodal diseases (with 3 pure, central nervous system relapses). At ABMT, 15 patients were in second complete remission and 4 were in second partial remission. All patients received carmustine (300 mg/m2 on day l), etoposide and cytarabine (both 100 mg/m2 every 12 h on days 2-5) and melphalan (140 mg/m2 on day 6). 4 patients also received a boost of radiotherapy at 20 Gy in involved fields after ABMT. Ex zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA vivo purging of bone marrow was done in 7 patients; immunological purging with two pan B monoclonal antibodies (CD20) in 3 cases [9], and chemical purging with Asta Z at adapted doses [lo] in 4 cases. Correspondence fo Ph. Colombat. Ph. Colombat and J.P. Lamagnere are at the Department of Haema- tology and Oncology, CHU Bretonneau, 2 bis Boulevard Tonnell& 37044 Tours Cedex, France; P. Biron and Th. Philip are at the Bone Marrow Transplantation Unit, Centre LCon Bt+ard, Lyon; J.P. Laporte and N.C. Gorin are at the Bone Marrow Transplantation Unit, HBpital Saint Antoine, Paris; and J.Y. Cahn and I’. Herve are at the Bone Marrow Transplantation Unit, HBpital Jean Minjoz, Besancon, France. Time months zyxwvutsrqponmlkjihgfedcbaZYXW Fig. 1. Kaplan-Meier estimate of the probability of disease-free survival. Each tick represents a surviving patient in complete remission. 12 patients are alive and 11 are disease-free with an actuarial disease-free survival of 62% and a median follow-up of 54 months (24-72) (Fig. 1). 6 patients relapsed 4,4,4,8,9, and 28 months after ABMT. 2 patients died during therapy, 1 of Aspergillus pneumoniae at day 15 and 1 of sudden death at day 35. The median recovery of leucocytes to over lo911 was day 19 (10-29); of neutrophils to over 0.5 X 109/1, day 20 (10-30); and of platelets to over 50 x 109/1, day 25 (14 to after 150). Thus ABMT can induce a long-term disease-free survival of about 60% in !irst chemosensitive relapses of NHL. BEAM was an efficacious c&ditioning regimen with low toxicity in this type of patient. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Appelbaum FR, Herzig GP, Ziegler JL, Graw RG, Levine AS, Deisseroth AB. Successful engraftment of cryopreserved autologous bone marrow in patients with malignant lymphoma. Blood 1978, 52,85-95. Armitage JO, Jagannath S, Spitzer G et al. High dose therapy and autologous bone marrow transplantation in patients with diffuse large cell lymphoma. EurJ Cancer Clin OncoZl986,22,871-877. Cannelos GP, Nadler L, Takvorian T. Autologous bone marrow transplantation in the treatment of malignant lymphoma and Hodg- kin’s disease. Semin Hematoll988,25,58-65. Colombat Ph, Lemonnier MP, Laporte JP et al. The role of autologous bone marrow transplantation in 46 adult patients with non Hodgkin’s lymphomas. 3 Clin Oncoll990,8,630-637. Golstone AH, Singer CRJ, Gribben JG, Jarert M. Fifth report of EBMT G experience of ABMT in malignant lymphoma-Proc. XIVth Annual Meeting of EBMT, Chamonix 1988. Bone M arrow Transplant 1988,3,33-36. Gulati SC, Shank B, Black P et al. Autologous bone marrow transplantation for patients with poor-prognosis lymphoma. 3 Clin O n~oll988,6,1303- 1313. Philip T, Armitage JO, Spitzer G et nl. High dose chemotherapy and autologous bone marrow transplantation after failure of conven- tional chemotherapy in adults with intermediate grade or high grade non Hodgkin’s lymphoma. N EngZJM ed 1987,316,1493- 1498. Takvorian T, Canellos GP, Ritz J et al. Prolonged disease-free survival after autologous bone marrow transplantation in patients with non Hodgkin’s lymphoma with a poor prognosis. N Engl3 M ed 1987,316,1499-1505. Favrot MC, Philip I, Philip T. Bone marrow purging procedure in Burkitt lymphoma with monoclonal antibodies and complement quantification by a liquid all culture monitoring system. Br 3 Haematoll986,64,161-168. Gorin NC, Douay L, Laporte JP et al. Autologous bone marrow transplantation using marrow incubated wirh Asta Z 7557 in adulr leukemia. Blood 1986,67, 1367- 1376. Correction The role of tamoxifen in the prevention of breast cancer.- We apologise to Mr Ian Fentiman for omitting four words from this Comment and Critique (Vol. 26, no. 6, p. 655). The third sentence of the third paragraph should have read: “The most easily recognised factor is a family history (first-degree relative developing the disease before age 50 or two first-degree relatives after age 50). ”