MCVAC regimen in autologous peripheral blood stem cell transplantation for high-risk diffuse large B cell lymphoma (DLBCL)

Background: High dose chemotherapy followed by autologous stem cell transplantation in high-risk or relapsed aggressive non-Hodgkin’s lymphoma (NHL) has been reported to improve survival. However, optimal conditioning regimen has yet to be determined. We have conducted a single institute study to evaluate the safety and efficacy of MCVAC regimen followed by autologous PBSCT for high-risk NHL. Patients and Methods: Adult patients with high-risk or relapsed DLBCL were eligible. MCVAC regimen consisted of ranimustine (250 mg/m2 on day −9 and 200 mg/m2 on day −4), cytarabine (2.0 g/m2 twice daily on days −8 to −5), etoposide (200 mg/m2 twice daily on days −8 to −5), and cyclophosphamide (50 mg/kg on days −3 and −2) followed by unpurged PBSCT. Granulocyte-colony stimulating factor were intravenously given from day 1 until neutrophil recovery. Results: Forty patients were enrolled and evaluable (median age; 51 years old). Disease status at transplant was CR in 22, and non-CR in 18 patients. Median follow-up was 33.3 months. Five-year overall survival (OS) and progression free survival (PFS) were 61.3% and 60.9%, respectively. Five-year OS was 58.1% in CR patients and 63.6% in non-CR patients (not significant), and 5-year PFS was 61.4% in CR patients and 59.6% in non-CR patients (not significant). Within 30 days after transplant, only 1 patient (2.5%) died of treatment-related complication (acute myocardial toxicity due to cyclophosphamide). In 2 patients, secondary MDS/AML was diagnosed at 20.3 and 94.7 months after transplant. Conclusions: We conclude that MCVAC regimen would be an effective and tolerable non-TBI regimen in autologous PBSCT for high-risk or relapsed DLBCL, and disease status at transplant did not affect the survival.