Patients with intermediate grade non-Hodgkin's lymphoma (NHL) who relapse or fail to achieve a complete remission after anthracycline-containing induction regimens have a poor outcome with conventional-dose salvage treatment. This outcome may be improved with intensive therapy and autologous transplantation (ABMT) but even in patients with proven chemotherapy-sensitive disease, relapse rates of up to 60% are observed. Reliable and powerful prognostic indicators are needed to identify appropriate patients for this expensive procedure and those subjects to whom alternative or additional treatment should be offered. We were interested in testing the hypothesis that tumour burden, and hence remission status immediately prior to transplant, is an important prognostic indicator of survival. We aggressively treated patients with conventional-dose salvage chemotherapy to maximum tumour response, and tested, by multivariate regression analysis, predictors of outcome post-transplant. We studied 81 consecutive patients with intermediate grade and immunoblastic NHL who achieved either a partial (PR) or complete remission (CR) following repetitive cycles of conventional-dose salvage therapy. Intensive therapy consisted of etoposide (60 mg/kg) and intravenous melphalan (160-180 mg/m2) with or without total body irradiation (TBI) followed by infusion of autologous unpurged bone marrow and/or blood cells. The predicted 4-year survival and progression-free survival (PFS) with a median follow-up of 37 months was 58% and 48% (95% confidence interval (CI) 37-55%), respectively. The only factor predictive of outcome was remission status at transplant (P=0.0001). The PFS at 4 years for the CR group was 61% (95% CI 53-75%). In contrast, only 25% (95% CI 11-40%) of patients undergoing autotransplant in PR were progression free at 4 years. We conclude that remission status at transplant after maximum tumour reduction is a powerful prognostic indicator.

Summary:Patient population and methodsThe charts of 350 consecutive patients between the ages of Thyroid function abnormalities in 270 adult patients post-BMT are described. Various conditioning regimens 16 and 57 years transplanted at this Institute from June 1970 to May 1994 and who survived at least 1 year from were used and the effects of three TBI and one chemotherapy only based regimens are compared. The overall transplant were reviewed. Reports of thyroid-related clinical abnormalities confirmed on laboratory testing as well incidence of elevated TSH is 8.9; 3.8, 7.2 and 16.7% in those patients who received 300, 500 and 1200 cGy as routine TSH, T3 and T4 levels were collected. Eighty patients from this cohort were excluded for lack of recorded respectively and 11.7% in those who received BuCy conditioning. Three cases (1.1%) of clinial hypothyroidism TSH levels. Males and females were approximately equally represented, respectively 136 vs 134 patients in the 270 were observed. Compensated hypothyroidism defined as an elevated TSH in the presence of normal T3, T4 levels available patients. The hematological diagnoses included, CML 98 patients; AML 93; ALL 27; AA 23; MDS 9; nonand transient in some cases, was the most common finding. All but four cases occurred in the first 2 years after Hodgkin's lymphoma (NHL) 8; others 12. Two hundred and ten patients received total body irradiation (TBI) from BMT. In the remaining four, three occurred in patients with chronic GVHD. The results reported here show a a 60 Co source at 50-90 cGy/min as a component of the conditioning regimen (Table 1) The remainder received cyclolower prevalence than observed in most other reviews, particularly for children. A trend was observed with phosphamide and busulfan. increasing radiation doses. The results are not significantly different from those we observed in the BuCy regimen.Results Keywords: allogeneic; BMT; thyroid Twenty-four of the 270 patients (10 males, 14 females) were found to have elevated TSH levels ( Table 2). The conditioning regimens in these patients included single fraction With the increase in the number of allogeneic bone marrow TBI in 12 (one received 300 cGy), fractionated TBI in five transplants performed over the last two decades, and the and no TBI in seven. This represents 3.8% of the patients concomitant decrease in early mortality due to infection, in the cohort treated with a single 300 cGy fraction, 7.2% graft failure and GVHD, long-term sequelae of transplanof those treated with a single 500 cGy fraction, 16.7% of tation have become more evident. 1-3 Endocrine abnormalithose treated with 1200 cGy in six fractions and 11.7% of ties, notably hypopituitarism, hypogonadism and hypothythose treated with no radiation in the conditioning regimen. roidism have been reported, primarily in transplanted This trend did not reach statistical significance. Significant children. 4,5 The frequency of hypothyroidism was found to acute GVHD (grade II-IV) developed in 18 of these be as high as 40%, 6-8 and appeared t...