Thoracic stop-flow perfusion for refractary lymphoma: a phase I-II evaluation trial

Background: Management of patients with heavily pretreated malignant lymphoma failing front-line treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue is problematic. A phase I-II evaluation trial was conducted to evaluate thoracic stop-flow perfusion. Patients and Methods: nine refractory patients were enrolled in the study. The schedule of thoracic stop-flow perfusion was based on cisplatin ( 100 mg/m2) and melphalan ( 25 mg/m2) . Melphalan pharmacokinetic analyses were performed. All patients received hemofiltration during each procedure. Results: Overall 18 cycles of perfusional chemotherapy were administerd. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. Hematological and non-hematological toxicity was mild in relation to the use of hemofiltration during the procedures. All 9 patients responded favourably to stop-flow therapy. We observed 5 CR and 4 PR. Four out of five patients in CR relapsed. Three out of these four died of progressive disease after a response duration of 9, 7 and 7 months, respectively. One patient had a duration of CR of 10 months before relapse. He attained a new PR ( + 3 months) . The remaining complete responder is still in remission aftre 37+ months. The 4 patients in PR progressed and died after a response duration of 4, 6, 2 and 1 month, respectively. To date, 8 out of 9 patients have died and one is still alive. Conclusion: Thoracic stop-flow perfusion seems very active in this kind of patient.