HIGH DOSE CHEMORADIOTHERAPY WITH PERIPHERAL BLOOD PROGENITOR CELL TRANSPLANTATION FOR PATIENTS WITH PRIMARY REFRACTORY, RELAPSED AND POOR PROGNOSIS NON-HODGKIN'S LYMPHOMA

OBJECTIVES:

• Determine the efficacy of mobilization using filgrastim (G-CSF) with or without standard-dose ifosfamide, carboplatin, and etoposide (ICE), conditioning using ifosfamide and etoposide plus total body irradiation or high-dose ICE, and autologous peripheral blood stem cell (PBSC) transplantation as salvage therapy in patients with refractory, recurrent, or poor prognosis non-Hodgkin's lymphoma.
• Determine the efficacy of reinduction comprising ICE followed by autologous PBSC transplantation in these patients.
• Determine the ability of standard-dose ICE combined with hematopoietic growth factors to mobilize PBSC in these patients.
• Determine the contamination of PBSC by lymphoma cells in patients treated with this mobilization regimen.
• Determine the quality of life of patients treated with this regimen.

OUTLINE: Patients are stratified according to disease status (relapsed vs refractory), lymphoma grade (low vs intermediate vs high), number of extranodal sites, serum lactic dehydrogenase, performance status, age, and volume of disease.

• Mobilization/harvest: Patients in first or greater complete remission (CR) are treated on regimen A, whereas patients with recurrent or refractory disease are treated on regimen B.

• Regimen A: Patients with poor prognosis intermediate-grade lymphoma (IGL) in first CR or IGL or low-grade lymphoma (LGL) in second or greater CR receive mobilization with filgrastim (G-CSF) subcutaneously (SC) daily on days 1-7. Autologous peripheral blood stem cells (PBSC) are harvested and selected for CD34+ cells on days 5 and 6 (and day 7 if needed).

• Regimen B: Patients who are currently on the MSKCC standard dose salvage therapy protocol with ifosfamide, carboplatin, and etoposide (ICE) for recurrent or refractory IGL receive additional mobilization with G-CSF after completion of the last course of ICE. Patients with recurrent or refractory IGL, immunoblastic lymphoma, or LGL who have not previously received ifosfamide and are not currently on the MSKCC standard dose salvage protocol with ICE receive ifosfamide IV and carboplatin on day 2 and etoposide IV on days 1-3 (standard-dose ICE) followed by G-CSF SC. When blood counts recover, autologous PBSC are harvested and selected for CD34+ cells.

• Regimens A and B: If additional hematopoietic growth factors (HGFs) become available, they may be administered concurrently with G-CSF. If inadequate CD34+ cells are collected, then autologous bone marrow is harvested.

• Conditioning: Patients who are under age 60 and have not received dose-limiting radiotherapy are treated on regimen C. Patients who are age 60 and over and patients who are under age 60 and have received dose-limiting radiotherapy are treated on regimen D.