Autologous blood stem cell transplantation for Hodgkin and non-Hodgkin lymphoma: complications and outcome

Background. We analysed data on patients of Hodgkin and non-Hodgkin lymphoma treated with high dose chemotherapy followed by autologous stem cell transplantation to determine the toxicity, pattern of infections and long term outcome. Methods. There were 34 male and 10 female patients (median age 35 years, range 15-67 years). Before transplantation, 31 patients (70.5%) had chemosensitive disease and 13 (29.5%) had chemoresistant disease. Granulocyte-colony stimulating factor mobilized peripheral blood stem cells were used as the source of stem cells. The patients received high dose chemotherapy using CBV (cyclophosphamide, BCNU and VP- 16 [etoposide] n=38), BEAM (BCNU, etoposide, cytosine arabinoside and melphalan, n=3), cytosine arabinoside, etoposide and melphalan (n=2) and melphalan alone (n=1). Prophylaxis with antifungal drugs (fluconazole/itraconazole) and acyclovir was used. Results. Following transplant, 32 patients (72.7%) responded; complete response was achieved in 25 patients (56.8%) and partial response in 7 (15.9%). The rate of complete response was higher for patients with pre-transplant chemosensitive disease (23/31 [74.2%] v. 2/13 [15.4%], p<0.001). Gastrointestinal toxicity, and renal and liver dysfunctions were major non-haematological toxicities; 3 patients (7%) died of regimen-related toxicity. Infections (predominantly Gram-negative) accounted for 2 deaths (4.5%) seen before day 30. At a median follow up of 79 months (range 14-168 months), median overall and event-free survival were 78 months and 28 months, respectively. Estimated mean (SE) overall and event-free survival at 60 months were 54.34% (0.07) and 34.3% (9.88), respectively. Conclusion. Patients with pre-transplant chemosensitive disease and those who achieved complete response following transplant had a significantly better chance of survival