Role of high-dose therapy and initial response in survival of poor-risk patients with aggressive non-Hodgkin's lymphoma: a retrospective series on 126 patients from a single center

Abstract

Summary:It is now established that a subgroup of non-Hodgkin's lymphoma (NHL) patients probably benefit from highdose therapy (HDT). We therefore retrospectively analyzed survival of 126 consecutive patients with large cell lymphoma (LCL) and high-intermediate (HI) or highrisk (H) age-adjusted international prognostic index (Aa-IPI). They received either standard chemotherapy (CT) (66 patients), or HDT (60 patients). Distribution of the Aa-IPI scores showed no statistical significant difference between the two treatment groups. Complete response (CR) rate was 51% for the whole series, with 41% and 62% for the standard CT group and HDT group, respectively. With a median follow-up of 63 months (range, 16 to 159), the 5-year overall survival (OS) and event-free survival (EFS) for all patients was 52% and 43%, respectively. There was a statistical significant difference in terms of survival towards the HDT group: OS at 76% vs 31%, EFS at 64% vs 24%. Patients who achieved CR with front-line therapy had a 5-year OS at 70%, while it was 34% for patients who were not in CR. These results are comparable to those reported in the literature, and strongly suggest that both initial CR achievement and HDT as front-line treatment are predictive factors for prolonged survival of patients with poor-risk LCL. Bone Marrow Transplantation (2000) 25, 35-40. Keywords: aggressive lymphoma; standard chemotherapy; high-dose therapy; complete response; survival Among non-Hodgkin's lymphomas (NHL), large cell lymphomas (LCL) have been recently well characterized in the Revised European-American Lymphoma (REAL) classification. 1 The CHOP regimen (doxorubicine, cyclophosphamide, vincristine, prednisone) has been extensively used in the treatment of LCL patients, and may cure approximately 30% of patients. 2 Many combination chemotherapy regimens modeled after CHOP have been tested in order

Intensive sequential chemotherapy with hematopoietic growth factor support for non‐Hodgkin lymphoma in patients infected with the human immunodeficiency virus

“…This intrathecal regimen represents the standard treatment used at our institution for both involved and non‐involved cerebrospinal fluid. 24, 25, 30…”

Efficacy of an early intensification treatment integrating chemotherapy, autologous stem cell transplantation and radiotherapy for poor risk primary mediastinal large B cell lymphoma with sclerosis

“…[9][10][11][12] Durable responses and a high rate of cure have also been observed after ASCT in patients with poor prognosis recurrent or refractory mediastinal large cell lymphoma. [12][13][14] In the setting of large cell lymphomas the GELA (Groupe d'Etude des Lymphomes de l'Adulte) study clearly demonstrated that patients with high, high-intermediate risk disease according to AA-IPI had a poor out-come when treated with conventional chemotherapy, but had survivals significantly improved by high-dose therapy and ASCT. [15][16][17] The aim of our study was to evaluate the role of an early intensification treatment integrating induction CHT, ASCT and RT in patients with primary MLCL with sclerosis presenting with adverse prognostic factors.…”

Identification of biological markers of sensitivity to high-clinical-risk-adapted therapy for patients with diffuse large B-cell lymphoma

“…There is a consensus that high-clinical-risk DLBCL subjects require a risk-adapted therapy, because intensification of chemotherapy with autologous stem-cell transplantation (ASCT) has been shown to improve the prognosis for these high-risk patients in previous randomised clinical trials [1][2][3][4]. Nevertheless, the therapeutic protocols used for these patients have a high morbidity, associated with ASCT and the use of multiple drugs.…”