Frontline Therapy with Early Intensification and Autologous Stem Cell Transplantation versus Conventional Chemotherapy in Unselected High-Risk, Aggressive Non-Hodgkin’s Lymphoma Patients: A Prospective Randomized GEMOH Report

Abstract

This prospective multicenter randomized trial compares conventional with early intensification with high-dose sequential chemotherapy (HDS) and autologous stem cell transplantation (ASCT) as frontline therapy in high-risk non-Hodgkin lymphomas (NHL). Newly diagnosed patients with aggressive high-risk [intermediate-high (HI) and high-risk (HR)] NHL according to the international prognosis index (IPI) were randomized to receive 12-week VACOP-B (arm A, 27 patients) or 6-week VACOP-B followed by HDS and ASCT (arm B, 29 patients). Complete remission rate was52% in arm A and 55% in B. Nine patients (16%) died early due to progression. According to intention-to-treat, with a median follow-up of 23 months, the 5-year actuarial overall survival, progression-free survival and disease-free survival in arms A and B were 47 and 40% (p = nonsignificant), 47 and 30% (p = nonsignificant), and 97 and 47% (p = 0.02), respectively. Abbreviated chemotherapy followed by intensification with HDS-ASCT does not seem to be superior to conventional chemotherapy in HI/HR aggressive NHL.

Use of rituximab in diffuse large B‐cell lymphoma in the salvage setting

“…Several forms of sequential intensive chemotherapy have been developed for use immediately prior to ASCT (Cuttica et al , 2003; van Imhoff et al , 2005; Josting et al , 2005; Olivieri et al , 2005a; Baldissera et al , 2006; Betticher et al , 2006), and incorporation of rituximab into such regimens could potentially improve outcomes without substantially increasing toxicity. One such schedule has been developed by the Italian group GITIL (Gruppo Italiano Terapie Innovative nei Linfomi), and consists of three courses of doxorubicin, vincristine and prednisone (debulking), followed by high‐dose sequential chemotherapy with cyclophosphamide, methotrexate, vincristine and etoposide (Cuttica et al , 2003).…”

Possibilities and Difficulties of Treatment in the Case of a Pregnant Patient with Primary Mediastinal Large B-cell Lymphoma

“…Th erapeutic response must be very carefully followed, because if after 4 courses we do not have good response to treatment, we must switch to so called "salvage" regimens like DHAP, ESHAP (Etoposid, Cisplatin, Cytosar, dexametasone) in the case of aggressive lymphomas [4]. Autologous hematopoietic stem cell transplantation is a very important modality of treatment and it can lead to cure of patients with DLBCL, as we presented in our clinical case [5,6].…”

Standard chemotherapy is superior to high-dose chemotherapy with autologous stem cell transplantation on overall survival as the first-line therapy for patients with aggressive non-Hodgkin lymphoma: a meta-analysis

“…However, five studies had no data available, one trial was ongoing, and five studies [8][9][10][11][12] could not be included in the analysis as the data reported did not permit a detailed evaluation (We also tried to contact the corresponding authors of two of the excluded studies, but there was no reply). Finally, 14 RCTs were included in this metaanalysis [13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…We calculated the overall survival at 36 months for the fourteen studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The variation in the overall survival probabilities between studies was not statistically (Fig.…”