Adult patients with advanced non-Hodgkin's lymphoma in whom conventional chemotherapy has failed are seldom cured thereafter. We studied 100 such patients with intermediate-grade or high-grade non-Hodgkin's lymphoma who were subsequently treated with high-dose chemotherapy (61 patients) or high-dose chemotherapy plus total-body irradiation (39 patients), with bone marrow transplantation used for hematologic support. Thirty-four patients had disease that had been refractory to primary chemotherapy, and 66 patients had had a complete remission with primary chemotherapy but later relapsed. Before autologous bone marrow transplantation and high-dose chemotherapy, the 66 relapsed patients had also received conventional salvage chemotherapy; 22 had had no response or had had disease progression (a response termed “resistant relapse”), and 44 patients had responded partially or completely (a response termed “sensitive relapse”). After high-dose therapy and bone marrow transplantation, the actuarial three-year diseasefree survival was zero in the refractory group, 14 percent in the resistant-relapse group, and 36 percent in the sensitive-relapse group. Patients who had had a complete remission in response to initial chemotherapy had a higher disease-free survival rate than those who had not (P<0.001), and patients with sensitive relapse had a higher disease-free survival rate than those with resistant relapse (P<0.003). These results should be considered in the planning or interpretation of trials of salvage chemotherapy in adults with non-Hodgkin's lymphoma. (N Engl J Med 1987; 316:1493–8.), PATIENTS with advanced diffuse non-Hodgkin's lymphoma are rarely cured of their disease after conventional chemotherapy fails. However, experience gained in Burkitt's lymphoma has shown that these lymphomas are still sensitive to intensive chemoradiotherapy after the failure of treatment with a conventional dosage.1 2 3 4 5 6 With bone marrow transplantation providing hematologic support, it has been possible to administer intensive chemoradiotherapy and to cure some children or adults with disseminated, aggressive non-Hodgkin's lymphoma.7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Many questions about such a program remain unanswered. The issue of autologous versus allogeneic marrow rescue and, in the case of autologous bone marrow transplantation, the value of various methods of….
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