Institution: MODENA MED CLINIC Sign In as Individual -------------------------------------------------------------------------------Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Blood 90: 3844-3852. Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Blood First Edition Paper, prepublished online April 3, 2003; DOI 10.1182/blood-2002-12-3837 Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Blood 95: 3687-3692. -------------------------------------------------------------------------------Abstract 1 of 5 Blood, 1 October 2000, Vol. 96, No. 7, pp. 2399-2404 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis Tarun Kewalramani, Andrew D. Zelenetz, Eric E. Hedrick, Gerard B. Donnelly, Sonia Hunte, Anna C. Priovolos, Jing Qin, Nancy Coady Lyons, Joachim Yahalom, Stephen D. Nimer, and Craig H. Moskowitz From the Memorial Sloan-Kettering Cancer Center, New York, NY. High-dose chemoradiotherapy (HDT) with autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed aggressive non-Hodgkin lymphoma (NHL). However, its role in the treatment of patients with primary refractory disease is not well defined. The outcomes of 85 patients with primary refractory aggressive NHL who underwent second-line chemotherapy with ICE with the intent of administering HDT/ASCT to those patients with chemosensitive disease were reviewed. Patients were retrospectively classified as induction partial responders (IPR) if they attained a partial response to doxorubicin-based front-line therapy or as induction failures (IF) if they had less than partial response. Forty-three patients (50.6%) had ICEchemosensitive disease; there was no difference in the response rate between the IPR and the IF groups. Intention-to-treat analysis revealed that 25% of the patients were alive and 21.9% were event-free at a median follow-up of 35 months. Among 42 patients who underwent transplantation, the 3-year overall and event-free survival rates were 52.5% and 44.2%, respectively, similar to the outcomes for patients with chemosensitive relapsed disease. No differences were observed between the IPR and IF groups, and there were no transplantation-related deaths. More than one extranodal site of disease and a second-line age-adjusted International Prognostic Index of 3 or 4 before ICE chemotherapy were predictive of poor survival. These results suggest that patients with primary refractory aggressive NHL should receive second-line chemotherapy, with the intent of administering HDT/ASCT to those with chemosensitive disease. Newer therapies are needed to improve the outcomes of patients with poor-risk primary refractory disease. Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman From the Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA; and the Bone Marrow Transplant Program, Stanford University Medical Center, Stanford, CA We have conducted a pilot study to investigate the role of high-dose therapy and autologous bone marrow/stem cell transplantation (ASCT) during first complete or partial remission in 52 patients with poor-risk aggressive lymphoma. There were 42 patients with intermediate-grade or immunoblastic lymphoma who were considered to be high (60%) and high-intermediate risk (40%) groups at diagnosis based on the age-adjusted International Prognostic Index (IPI) and 10 patients with high-grade, SNCCL (small non-cleaved cell, Burkitt's, and non-Burkitt's), who at presentation had poor-risk features defined as elevated serum lactate dehydrogenase level, stage IV, and bulky mass 10 cm. The median age was 34 years (range, 16 to 56 years). Thirty-nine were transplanted in first complete remission and 13 in first partial remission after conventional therapy. Conditioning regimens consisted of total body irradiation (TBI) administered as a single fraction 750 cGy in 3 patients and in fractionated doses for a total of 1,200 cGy in 44 patients, in combination with 60 mg/kg etoposide and 100 mg/kg cyclophosphamide. Five patients with prior radiotherapy received 450 mg/m2 carmustine instead of TBI. Stem cell sources were either bone marrow and/or peripheral blood. No in vitro purging was used. All patients engrafted. Two SNCCL patients died of venoocclusive disease at 25 days and acute leukemia at 27 months posttransplantation. There were six relapses at 1.5 to 12.8 months posttransplantation. At a median follow-up of 44 months (range, 1 to 113 months), the estimated 3-year overall survival (OS) and disease-free survival (DFS) for all patients was 84% (95% confidence interval [CI], 70% to 92%) and 82% (95% CI, 68% to 91%), respectively. In the subset of patients with intermediate-grade and immunoblastic lymphoma, the 3year DFS was 89% (95% CI, 74% to 96%) for all patients, 87% (95% CI, 67% to 96%) for highrisk patients, and 92% (95 CI, 61% to 99%) for high-intermediate risk patients. The 3-year OS and DFS for SNCCL patients were identical at 60% (95% CI, 30% to 84%). These results suggest that high-dose therapy and ASCT during first remission may improve the survival and prognosis of patients with poor-risk intermediate- and high-grade lymphoma. A prospective randomized study comparing high-dose therapy and ASCT with conventional chemotherapy in IPI high-risk patients with aggressive non-Hodgkin's lymphoma should be undertaken. Blood, Vol. 90 No. 10 (November 15), 1997: pp. 3844-3852 © 1997 by The American Society of Hematology. [Full Text of Nademanee et al.] [Reprint (PDF) Version of Nademanee et al.] -------------------------------------------------------------------------------Abstract 3 of 5 Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Laurie H. Sehn, Joseph H. Antin, Lawrence N. Shulman, Peter Mauch, Anthony Elias, Marshall E. Kadin, and Catherine Wheeler From the Hematology-Oncology Division, Brigham and Women's Hospital; Hematology-Oncology Division and Department of Pathology, Beth Israel Hospital; Joint Center for Radiation Therapy, Division of Medical Oncology, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA. We performed a retrospective analysis of 35 patients with primary diffuse large B-cell lymphoma of the mediastinum treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) plus autologous hematopoietic cell transplantation to determine outcome and prognostic features for progression-free survival (PFS). Thirty-five patients with primary diffuse large B-cell lymphoma of the mediastinum in first response (complete remission [CR] or partial remission [PR]) with poor prognostic features, with primarily refractory disease, or with relapsed disease following conventional chemotherapy, were treated with CBV and autologous hematopoietic cell transplantation. PFS and overall survival were assessed by the Kaplan-Meier method. Patient characteristics before transplantation were examined by univariate analysis using the log-rank test and by Cox's proportional hazards regression analysis to determine predictors of PFS. Estimated 5year PFS varied significantly with patient disease status at transplantation. Patients transplanted in first response had an estimated 5-year PFS rate of 83%, compared with 58% and 27% for primarily refractory and relapsed patients, respectively (P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapyresponsive disease had a significantly greater PFS rate than patients with chemotherapynonresponsive disease (risk ratio, 3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors were found to be significant on univariate or multivariate analysis. Patients with primary diffuse large B-cell lymphoma of the mediastinum can achieve prolonged PFS following high-dose chemotherapy and autologous hematopoietic cell transplantation. Outcomes are strongly correlated with disease status (first response v refractory v relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation. Blood, Vol. 91 No. 2 (January 15), 1998: pp. 717-723 © 1998 by The American Society of Hematology. [Full Text of Sehn et al.] [Reprint (PDF) Version of Sehn et al.] -------------------------------------------------------------------------------Abstract 4 of 5 Submitted December 19, 2002 Accepted March 20, 2003 The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz* Department of Medicine - Lymphoma Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine - Hematology Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Radiation Oncology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Biostatistics, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA * Corresponding author; email: moskowic@mskcc.org. Second-line chemotherapy followed by high dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In three sequential clinical trials, conducted from 1/93 to 8/00, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted international prognostic index at the initiation of second-line therapy (sAAIPI) as a predictor of progression free survival (PFS) and overall survival (OS). At a median followup of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors) 70% and 74%; intermediate risk (1 factor) 39% and 49%; and high risk (2 or 3 factors) 16% and 18% (p<0.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICE chemosensitive disease: low risk 69% and 83%; intermediate risk 46% and 55%; and high risk 25% and 26% (p<0.001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens. [Reprint (PDF) Version of Hamlin et al.] -------------------------------------------------------------------------------Abstract 5 of 5 Blood, Vol. 95 No. 12 (June 15), 2000: pp. 3687-3692 Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage for the Groupe d'Etude des Lymphomes de l'Adulte (GELA) From the Département d'information hospitalier and Service d'hématologie clinique Hôpital Henri Mondor, AP-HP, Créteil, France; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Institut d'hématologie, Hôpital Saint Louis, AP-HP, Paris, France; Service d'hématologie, Centre Léon Bérard, Lyon, France; Service d'hématologie, Centre Hospitalier du Dr Schaffner, Lens, France; Service d'hématologie, CHU de Bordeaux, Pessac, France; Service d'hématologie, Institut Paoli Calmette, Marseille, France; Service d'hématologie, Centre Jolimont, La Louvière, Belgium; and Service d'hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France. Evaluating high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) in term of both duration and quality of life (QOL) presents major interests for patients with non-Hodgkin lymphoma. The quality-adjusted time without symptom and toxicity (Q-TWiST) methodology was applied to the LNH87-2 trial comparing HDT with ASCT versus sequential chemotherapy in 541 patients in first complete remission (CR). Overall survival (OS) and disease-free survival (DFS) curves were used to estimate duration of 4 health states: acute short-term toxicity (Tox1), secondary toxicity (Tox2), time without symptom and toxicity (TWiST), and relapse (Rel). Areas under survival curves (AUC) were retrospectively weighted according to QOL coefficients. HDT increased, but not significantly, TWiST (+2.4 months in AUC, P = .17) and decreased Rel (3 months, P < .01). Survival estimates did not differ between the 2 treatments (AUC 47.7 months for OS, 39.7 months for DFS). High-risk patients treated by HDT versus chemotherapy had a significant benefit in DFS (AUC 28.8 versus 24.9 months, P < .01) but not in OS (AUC 37.3 versus 36 months, P = .27). Sensitivity analysis, performed by varying QOL coefficients, demonstrated significant quality-adjusted survival gain in high-risk patients treated by HDT. In low-risk patients, a diagram provided an aid to clinical decision-making. This analysis supports the use of HDT in these patients with adverse prognostic factors in the first CR, even after adjusting for QOL using the Q-TWiST method. [Full Text of Mounier et al.] [Reprint (PDF) Version of Mounier et al.] -------------------------------------------------------------------------------- -------------------------------------------------------------------------------Blood Online is sponsored by an unrestricted grant from Shire Copyright © 2003 by American Society of Hematology. Institution: MODENA MED CLINIC Sign In as Individual -------------------------------------------------------------------------------Download ALL Selected Citations to Citation Manager Selected Abstracts Returned: 5 citations and abstracts. Click on down arrow or scroll to see abstracts. Tarun Kewalramani, Andrew D. Zelenetz, Eric E. Hedrick, Gerard B. Donnelly, Sonia Hunte, Anna C. Priovolos, Jing Qin, Nancy Coady Lyons, Joachim Yahalom, Stephen D. Nimer, and Craig H. Moskowitz High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis Blood 96: 2399-2404. Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Blood 90: 3844-3852. Laurie H. Sehn, Joseph H. Antin, Lawrence N. Shulman, Peter Mauch, Anthony Elias, Marshall E. Kadin, and Catherine Wheeler Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Blood 91: 717-723. Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Blood First Edition Paper, prepublished online April 3, 2003; DOI 10.1182/blood-2002-12-3837 Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Blood 95: 3687-3692. -------------------------------------------------------------------------------Abstract 1 of 5 Blood, 1 October 2000, Vol. 96, No. 7, pp. 2399-2404 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis Tarun Kewalramani, Andrew D. Zelenetz, Eric E. Hedrick, Gerard B. Donnelly, Sonia Hunte, Anna C. Priovolos, Jing Qin, Nancy Coady Lyons, Joachim Yahalom, Stephen D. Nimer, and Craig H. Moskowitz From the Memorial Sloan-Kettering Cancer Center, New York, NY. High-dose chemoradiotherapy (HDT) with autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed aggressive non-Hodgkin lymphoma (NHL). However, its role in the treatment of patients with primary refractory disease is not well defined. The outcomes of 85 patients with primary refractory aggressive NHL who underwent second-line chemotherapy with ICE with the intent of administering HDT/ASCT to those patients with chemosensitive disease were reviewed. Patients were retrospectively classified as induction partial responders (IPR) if they attained a partial response to doxorubicin-based front-line therapy or as induction failures (IF) if they had less than partial response. Forty-three patients (50.6%) had ICEchemosensitive disease; there was no difference in the response rate between the IPR and the IF groups. Intention-to-treat analysis revealed that 25% of the patients were alive and 21.9% were event-free at a median follow-up of 35 months. Among 42 patients who underwent transplantation, the 3-year overall and event-free survival rates were 52.5% and 44.2%, respectively, similar to the outcomes for patients with chemosensitive relapsed disease. No differences were observed between the IPR and IF groups, and there were no transplantation-related deaths. More than one extranodal site of disease and a second-line age-adjusted International Prognostic Index of 3 or 4 before ICE chemotherapy were predictive of poor survival. These results suggest that patients with primary refractory aggressive NHL should receive second-line chemotherapy, with the intent of administering HDT/ASCT to those with chemosensitive disease. Newer therapies are needed to improve the outcomes of patients with poor-risk primary refractory disease. © 2000 by The American Society of Hematology. [Full Text of Kewalramani et al.] [Reprint (PDF) Version of Kewalramani et al.] -------------------------------------------------------------------------------Abstract 2 of 5 Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman From the Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA; and the Bone Marrow Transplant Program, Stanford University Medical Center, Stanford, CA We have conducted a pilot study to investigate the role of high-dose therapy and autologous bone marrow/stem cell transplantation (ASCT) during first complete or partial remission in 52 patients with poor-risk aggressive lymphoma. There were 42 patients with intermediate-grade or immunoblastic lymphoma who were considered to be high (60%) and high-intermediate risk (40%) groups at diagnosis based on the age-adjusted International Prognostic Index (IPI) and 10 patients with high-grade, SNCCL (small non-cleaved cell, Burkitt's, and non-Burkitt's), who at presentation had poor-risk features defined as elevated serum lactate dehydrogenase level, stage IV, and bulky mass 10 cm. The median age was 34 years (range, 16 to 56 years). Thirty-nine were transplanted in first complete remission and 13 in first partial remission after conventional therapy. Conditioning regimens consisted of total body irradiation (TBI) administered as a single fraction 750 cGy in 3 patients and in fractionated doses for a total of 1,200 cGy in 44 patients, in combination with 60 mg/kg etoposide and 100 mg/kg cyclophosphamide. Five patients with prior radiotherapy received 450 mg/m2 carmustine instead of TBI. Stem cell sources were either bone marrow and/or peripheral blood. No in vitro purging was used. All patients engrafted. Two SNCCL patients died of venoocclusive disease at 25 days and acute leukemia at 27 months posttransplantation. There were six relapses at 1.5 to 12.8 months posttransplantation. At a median follow-up of 44 months (range, 1 to 113 months), the estimated 3-year overall survival (OS) and disease-free survival (DFS) for all patients was 84% (95% confidence interval [CI], 70% to 92%) and 82% (95% CI, 68% to 91%), respectively. In the subset of patients with intermediate-grade and immunoblastic lymphoma, the 3year DFS was 89% (95% CI, 74% to 96%) for all patients, 87% (95% CI, 67% to 96%) for highrisk patients, and 92% (95 CI, 61% to 99%) for high-intermediate risk patients. The 3-year OS and DFS for SNCCL patients were identical at 60% (95% CI, 30% to 84%). These results suggest that high-dose therapy and ASCT during first remission may improve the survival and prognosis of patients with poor-risk intermediate- and high-grade lymphoma. A prospective randomized study comparing high-dose therapy and ASCT with conventional chemotherapy in IPI high-risk patients with aggressive non-Hodgkin's lymphoma should be undertaken. Blood, Vol. 90 No. 10 (November 15), 1997: pp. 3844-3852 © 1997 by The American Society of Hematology. [Full Text of Nademanee et al.] [Reprint (PDF) Version of Nademanee et al.] -------------------------------------------------------------------------------Abstract 3 of 5 Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Laurie H. Sehn, Joseph H. Antin, Lawrence N. Shulman, Peter Mauch, Anthony Elias, Marshall E. Kadin, and Catherine Wheeler From the Hematology-Oncology Division, Brigham and Women's Hospital; Hematology-Oncology Division and Department of Pathology, Beth Israel Hospital; Joint Center for Radiation Therapy, Division of Medical Oncology, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA. We performed a retrospective analysis of 35 patients with primary diffuse large B-cell lymphoma of the mediastinum treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) plus autologous hematopoietic cell transplantation to determine outcome and prognostic features for progression-free survival (PFS). Thirty-five patients with primary diffuse large B-cell lymphoma of the mediastinum in first response (complete remission [CR] or partial remission [PR]) with poor prognostic features, with primarily refractory disease, or with relapsed disease following conventional chemotherapy, were treated with CBV and autologous hematopoietic cell transplantation. PFS and overall survival were assessed by the Kaplan-Meier method. Patient characteristics before transplantation were examined by univariate analysis using the log-rank test and by Cox's proportional hazards regression analysis to determine predictors of PFS. Estimated 5year PFS varied significantly with patient disease status at transplantation. Patients transplanted in first response had an estimated 5-year PFS rate of 83%, compared with 58% and 27% for primarily refractory and relapsed patients, respectively (P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapyresponsive disease had a significantly greater PFS rate than patients with chemotherapynonresponsive disease (risk ratio, 3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors were found to be significant on univariate or multivariate analysis. Patients with primary diffuse large B-cell lymphoma of the mediastinum can achieve prolonged PFS following high-dose chemotherapy and autologous hematopoietic cell transplantation. Outcomes are strongly correlated with disease status (first response v refractory v relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation. Blood, Vol. 91 No. 2 (January 15), 1998: pp. 717-723 © 1998 by The American Society of Hematology. [Full Text of Sehn et al.] [Reprint (PDF) Version of Sehn et al.] -------------------------------------------------------------------------------Abstract 4 of 5 Submitted December 19, 2002 Accepted March 20, 2003 The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz* Department of Medicine - Lymphoma Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine - Hematology Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Radiation Oncology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Biostatistics, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA * Corresponding author; email: moskowic@mskcc.org. Second-line chemotherapy followed by high dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In three sequential clinical trials, conducted from 1/93 to 8/00, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted international prognostic index at the initiation of second-line therapy (sAAIPI) as a predictor of progression free survival (PFS) and overall survival (OS). At a median followup of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors) 70% and 74%; intermediate risk (1 factor) 39% and 49%; and high risk (2 or 3 factors) 16% and 18% (p<0.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICE chemosensitive disease: low risk 69% and 83%; intermediate risk 46% and 55%; and high risk 25% and 26% (p<0.001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens. [Reprint (PDF) Version of Hamlin et al.] -------------------------------------------------------------------------------Abstract 5 of 5 Blood, Vol. 95 No. 12 (June 15), 2000: pp. 3687-3692 Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage for the Groupe d'Etude des Lymphomes de l'Adulte (GELA) From the Département d'information hospitalier and Service d'hématologie clinique Hôpital Henri Mondor, AP-HP, Créteil, France; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Institut d'hématologie, Hôpital Saint Louis, AP-HP, Paris, France; Service d'hématologie, Centre Léon Bérard, Lyon, France; Service d'hématologie, Centre Hospitalier du Dr Schaffner, Lens, France; Service d'hématologie, CHU de Bordeaux, Pessac, France; Service d'hématologie, Institut Paoli Calmette, Marseille, France; Service d'hématologie, Centre Jolimont, La Louvière, Belgium; and Service d'hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France. Evaluating high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) in term of both duration and quality of life (QOL) presents major interests for patients with non-Hodgkin lymphoma. The quality-adjusted time without symptom and toxicity (Q-TWiST) methodology was applied to the LNH87-2 trial comparing HDT with ASCT versus sequential chemotherapy in 541 patients in first complete remission (CR). Overall survival (OS) and disease-free survival (DFS) curves were used to estimate duration of 4 health states: acute short-term toxicity (Tox1), secondary toxicity (Tox2), time without symptom and toxicity (TWiST), and relapse (Rel). Areas under survival curves (AUC) were retrospectively weighted according to QOL coefficients. HDT increased, but not significantly, TWiST (+2.4 months in AUC, P = .17) and decreased Rel (3 months, P < .01). Survival estimates did not differ between the 2 treatments (AUC 47.7 months for OS, 39.7 months for DFS). High-risk patients treated by HDT versus chemotherapy had a significant benefit in DFS (AUC 28.8 versus 24.9 months, P < .01) but not in OS (AUC 37.3 versus 36 months, P = .27). Sensitivity analysis, performed by varying QOL coefficients, demonstrated significant quality-adjusted survival gain in high-risk patients treated by HDT. In low-risk patients, a diagram provided an aid to clinical decision-making. This analysis supports the use of HDT in these patients with adverse prognostic factors in the first CR, even after adjusting for QOL using the Q-TWiST method. [Full Text of Mounier et al.] [Reprint (PDF) Version of Mounier et al.] -------------------------------------------------------------------------------- -------------------------------------------------------------------------------Blood Online is sponsored by an unrestricted grant from Shire Copyright © 2003 by American Society of Hematology. Institution: MODENA MED CLINIC Sign In as Individual -------------------------------------------------------------------------------Download ALL Selected Citations to Citation Manager Selected Abstracts Returned: 5 citations and abstracts. Click on down arrow or scroll to see abstracts. Tarun Kewalramani, Andrew D. Zelenetz, Eric E. Hedrick, Gerard B. Donnelly, Sonia Hunte, Anna C. Priovolos, Jing Qin, Nancy Coady Lyons, Joachim Yahalom, Stephen D. Nimer, and Craig H. Moskowitz High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis Blood 96: 2399-2404. Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Blood 90: 3844-3852. Laurie H. Sehn, Joseph H. Antin, Lawrence N. Shulman, Peter Mauch, Anthony Elias, Marshall E. Kadin, and Catherine Wheeler Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Blood 91: 717-723. Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Blood First Edition Paper, prepublished online April 3, 2003; DOI 10.1182/blood-2002-12-3837 Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Blood 95: 3687-3692. -------------------------------------------------------------------------------Abstract 1 of 5 Blood, 1 October 2000, Vol. 96, No. 7, pp. 2399-2404 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis Tarun Kewalramani, Andrew D. Zelenetz, Eric E. Hedrick, Gerard B. Donnelly, Sonia Hunte, Anna C. Priovolos, Jing Qin, Nancy Coady Lyons, Joachim Yahalom, Stephen D. Nimer, and Craig H. Moskowitz From the Memorial Sloan-Kettering Cancer Center, New York, NY. High-dose chemoradiotherapy (HDT) with autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed aggressive non-Hodgkin lymphoma (NHL). However, its role in the treatment of patients with primary refractory disease is not well defined. The outcomes of 85 patients with primary refractory aggressive NHL who underwent second-line chemotherapy with ICE with the intent of administering HDT/ASCT to those patients with chemosensitive disease were reviewed. Patients were retrospectively classified as induction partial responders (IPR) if they attained a partial response to doxorubicin-based front-line therapy or as induction failures (IF) if they had less than partial response. Forty-three patients (50.6%) had ICEchemosensitive disease; there was no difference in the response rate between the IPR and the IF groups. Intention-to-treat analysis revealed that 25% of the patients were alive and 21.9% were event-free at a median follow-up of 35 months. Among 42 patients who underwent transplantation, the 3-year overall and event-free survival rates were 52.5% and 44.2%, respectively, similar to the outcomes for patients with chemosensitive relapsed disease. No differences were observed between the IPR and IF groups, and there were no transplantation-related deaths. More than one extranodal site of disease and a second-line age-adjusted International Prognostic Index of 3 or 4 before ICE chemotherapy were predictive of poor survival. These results suggest that patients with primary refractory aggressive NHL should receive second-line chemotherapy, with the intent of administering HDT/ASCT to those with chemosensitive disease. Newer therapies are needed to improve the outcomes of patients with poor-risk primary refractory disease. © 2000 by The American Society of Hematology. [Full Text of Kewalramani et al.] [Reprint (PDF) Version of Kewalramani et al.] -------------------------------------------------------------------------------Abstract 2 of 5 Results of High-Dose Therapy and Autologous Bone Marrow/Stem Cell Transplantation During Remission in Poor-Risk Intermediate- and High-Grade Lymphoma: International Index High and High-Intermediate Risk Group Auayporn Nademanee, Arturo Molina, Margaret R. O'Donnell, Andrew Dagis, David S. Snyder, Pablo Parker, Anthony Stein, Eileen Smith, Ina Planás, Ashwin Kashyap, Ricardo Spielberger, Henry Fung, K.K. Wong, George Somlo, Kim Margolin, Warren Chow, Irena Sniecinski, Nayana Vora, Karl G. Blume, Joyce Niland, and Stephen J. Forman From the Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA; and the Bone Marrow Transplant Program, Stanford University Medical Center, Stanford, CA We have conducted a pilot study to investigate the role of high-dose therapy and autologous bone marrow/stem cell transplantation (ASCT) during first complete or partial remission in 52 patients with poor-risk aggressive lymphoma. There were 42 patients with intermediate-grade or immunoblastic lymphoma who were considered to be high (60%) and high-intermediate risk (40%) groups at diagnosis based on the age-adjusted International Prognostic Index (IPI) and 10 patients with high-grade, SNCCL (small non-cleaved cell, Burkitt's, and non-Burkitt's), who at presentation had poor-risk features defined as elevated serum lactate dehydrogenase level, stage IV, and bulky mass 10 cm. The median age was 34 years (range, 16 to 56 years). Thirty-nine were transplanted in first complete remission and 13 in first partial remission after conventional therapy. Conditioning regimens consisted of total body irradiation (TBI) administered as a single fraction 750 cGy in 3 patients and in fractionated doses for a total of 1,200 cGy in 44 patients, in combination with 60 mg/kg etoposide and 100 mg/kg cyclophosphamide. Five patients with prior radiotherapy received 450 mg/m2 carmustine instead of TBI. Stem cell sources were either bone marrow and/or peripheral blood. No in vitro purging was used. All patients engrafted. Two SNCCL patients died of venoocclusive disease at 25 days and acute leukemia at 27 months posttransplantation. There were six relapses at 1.5 to 12.8 months posttransplantation. At a median follow-up of 44 months (range, 1 to 113 months), the estimated 3-year overall survival (OS) and disease-free survival (DFS) for all patients was 84% (95% confidence interval [CI], 70% to 92%) and 82% (95% CI, 68% to 91%), respectively. In the subset of patients with intermediate-grade and immunoblastic lymphoma, the 3year DFS was 89% (95% CI, 74% to 96%) for all patients, 87% (95% CI, 67% to 96%) for highrisk patients, and 92% (95 CI, 61% to 99%) for high-intermediate risk patients. The 3-year OS and DFS for SNCCL patients were identical at 60% (95% CI, 30% to 84%). These results suggest that high-dose therapy and ASCT during first remission may improve the survival and prognosis of patients with poor-risk intermediate- and high-grade lymphoma. A prospective randomized study comparing high-dose therapy and ASCT with conventional chemotherapy in IPI high-risk patients with aggressive non-Hodgkin's lymphoma should be undertaken. Blood, Vol. 90 No. 10 (November 15), 1997: pp. 3844-3852 © 1997 by The American Society of Hematology. [Full Text of Nademanee et al.] [Reprint (PDF) Version of Nademanee et al.] -------------------------------------------------------------------------------Abstract 3 of 5 Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Laurie H. Sehn, Joseph H. Antin, Lawrence N. Shulman, Peter Mauch, Anthony Elias, Marshall E. Kadin, and Catherine Wheeler From the Hematology-Oncology Division, Brigham and Women's Hospital; Hematology-Oncology Division and Department of Pathology, Beth Israel Hospital; Joint Center for Radiation Therapy, Division of Medical Oncology, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA. We performed a retrospective analysis of 35 patients with primary diffuse large B-cell lymphoma of the mediastinum treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) plus autologous hematopoietic cell transplantation to determine outcome and prognostic features for progression-free survival (PFS). Thirty-five patients with primary diffuse large B-cell lymphoma of the mediastinum in first response (complete remission [CR] or partial remission [PR]) with poor prognostic features, with primarily refractory disease, or with relapsed disease following conventional chemotherapy, were treated with CBV and autologous hematopoietic cell transplantation. PFS and overall survival were assessed by the Kaplan-Meier method. Patient characteristics before transplantation were examined by univariate analysis using the log-rank test and by Cox's proportional hazards regression analysis to determine predictors of PFS. Estimated 5year PFS varied significantly with patient disease status at transplantation. Patients transplanted in first response had an estimated 5-year PFS rate of 83%, compared with 58% and 27% for primarily refractory and relapsed patients, respectively (P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapyresponsive disease had a significantly greater PFS rate than patients with chemotherapynonresponsive disease (risk ratio, 3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors were found to be significant on univariate or multivariate analysis. Patients with primary diffuse large B-cell lymphoma of the mediastinum can achieve prolonged PFS following high-dose chemotherapy and autologous hematopoietic cell transplantation. Outcomes are strongly correlated with disease status (first response v refractory v relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation. Blood, Vol. 91 No. 2 (January 15), 1998: pp. 717-723 © 1998 by The American Society of Hematology. [Full Text of Sehn et al.] [Reprint (PDF) Version of Sehn et al.] -------------------------------------------------------------------------------Abstract 4 of 5 Submitted December 19, 2002 Accepted March 20, 2003 The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma Paul A Hamlin, Andrew D Zelenetz, Tarun Kewalramani, Jing Qin, Jaya M Satagopan, David Verbel, Ariela Noy, Carol S Portlock, David J Straus, Joachim Yahalom, Stephen D Nimer, and Craig H Moskowitz* Department of Medicine - Lymphoma Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine - Hematology Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Radiation Oncology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Biostatistics, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA * Corresponding author; email: moskowic@mskcc.org. Second-line chemotherapy followed by high dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In three sequential clinical trials, conducted from 1/93 to 8/00, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted international prognostic index at the initiation of second-line therapy (sAAIPI) as a predictor of progression free survival (PFS) and overall survival (OS). At a median followup of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors) 70% and 74%; intermediate risk (1 factor) 39% and 49%; and high risk (2 or 3 factors) 16% and 18% (p<0.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICE chemosensitive disease: low risk 69% and 83%; intermediate risk 46% and 55%; and high risk 25% and 26% (p<0.001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens. [Reprint (PDF) Version of Hamlin et al.] -------------------------------------------------------------------------------Abstract 5 of 5 Blood, Vol. 95 No. 12 (June 15), 2000: pp. 3687-3692 Quality of life-adjusted survival analysis of high-dose therapy with autologous bone marrow transplantation versus sequential chemotherapy for patients with aggressive lymphoma in first complete remission Nicolas Mounier, Corinne Haioun, Bernard F. Cole, Christian Gisselbrecht, Catherine Sebban, Pierre Morel, Gerald Marit, Reda Bouabdallah, Christophe Ravoet, Gilles Salles, Felix Reyes, and Eric Lepage for the Groupe d'Etude des Lymphomes de l'Adulte (GELA) From the Département d'information hospitalier and Service d'hématologie clinique Hôpital Henri Mondor, AP-HP, Créteil, France; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Institut d'hématologie, Hôpital Saint Louis, AP-HP, Paris, France; Service d'hématologie, Centre Léon Bérard, Lyon, France; Service d'hématologie, Centre Hospitalier du Dr Schaffner, Lens, France; Service d'hématologie, CHU de Bordeaux, Pessac, France; Service d'hématologie, Institut Paoli Calmette, Marseille, France; Service d'hématologie, Centre Jolimont, La Louvière, Belgium; and Service d'hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France. Evaluating high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) in term of both duration and quality of life (QOL) presents major interests for patients with non-Hodgkin lymphoma. The quality-adjusted time without symptom and toxicity (Q-TWiST) methodology was applied to the LNH87-2 trial comparing HDT with ASCT versus sequential chemotherapy in 541 patients in first complete remission (CR). Overall survival (OS) and disease-free survival (DFS) curves were used to estimate duration of 4 health states: acute short-term toxicity (Tox1), secondary toxicity (Tox2), time without symptom and toxicity (TWiST), and relapse (Rel). Areas under survival curves (AUC) were retrospectively weighted according to QOL coefficients. HDT increased, but not significantly, TWiST (+2.4 months in AUC, P = .17) and decreased Rel (3 months, P < .01). Survival estimates did not differ between the 2 treatments (AUC 47.7 months for OS, 39.7 months for DFS). High-risk patients treated by HDT versus chemotherapy had a significant benefit in DFS (AUC 28.8 versus 24.9 months, P < .01) but not in OS (AUC 37.3 versus 36 months, P = .27). Sensitivity analysis, performed by varying QOL coefficients, demonstrated significant quality-adjusted survival gain in high-risk patients treated by HDT. In low-risk patients, a diagram provided an aid to clinical decision-making. This analysis supports the use of HDT in these patients with adverse prognostic factors in the first CR, even after adjusting for QOL using the Q-TWiST method. [Full Text of Mounier et al.] [Reprint (PDF) Version of Mounier et al.] -------------------------------------------------------------------------------- -------------------------------------------------------------------------------Blood Online is sponsored by an unrestricted grant from Shire Copyright © 2003 by American Society of Hematology. HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH SEARCH RESULT QUICK SEARCH: [advanced] Author: Keyword(s): Year: Vol: Page: -------------------------------------------------------------------------------Download ALL Selected Citations to Citation Manager Selected Abstracts Returned: 6 citations and abstracts. Click on down arrow or scroll to see abstracts. Maurizio Martelli, Filippo Gherlinzoni, Amalia De Renzo, Pier Luigi Zinzani, Antonio De Vivo, Maria Cantonetti, Brunangelo Falini, Sergio Storti, Giovanna Meloni, Manuela Rizzo, Anna Lia Molinari, Francesco Lauria, Luciano Moretti, Vito Michele Lauta, Patrizio Mazza, Luciano Guardigni, E. Pescarmona, S.A. Pileri, Franco Mandelli, and Sante Tura Early Autologous Stem-Cell Transplantation Versus Conventional Chemotherapy as Front-Line Therapy in High-Risk, Aggressive Non-Hodgkin’s Lymphoma: An Italian Multicenter Randomized Trial J Clin Oncol 21: 1255-1262. Christian Gisselbrecht, Eric Lepage, Thierry Molina, Bruno Quesnel, Georges Fillet, Pierre Lederlin, Bertrand Coiffier, Hervé Tilly, Jean Gabarre, Francoise Guilmin, Olivier Hermine, and Félix Reyes Shortened First-Line High-Dose Chemotherapy for Patients With Poor-Prognosis Aggressive Lymphoma J Clin Oncol 20: 2472-2479. Julie M. Vose, Mei-Jie Zhang, Philip A. Rowlings, Hillard M. Lazarus, Brian J. Bolwell, Cesar O. Freytes, Santiago Pavlovsky, Armand Keating, Burhan Yanes, Koen van Besien, James O. Armitage, and Mary M. Horowitz Autologous Transplantation for Diffuse Aggressive Non-Hodgkin’s Lymphoma in Patients Never Achieving Remission: A Report from the Autologous Blood and Marrow Transplant Registry J Clin Oncol 19: 406-413. Corinne Haioun, Eric Lepage, Christian Gisselbrecht, Gilles Salles, Bertrand Coiffier, Pauline Brice, André Bosly, Pierre Morel, Christiane Nouvel, Hervé Tilly, Pierre Lederlin, Catherine Sebban, Josette Brière, Philippe Gaulard, and Félix Reyes Survival Benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Final Analysis of the Prospective LNH87–2 Protocol—A Groupe d’Etude des Lymphomes de l’Adulte Study J Clin Oncol 18: 3025-3030. Ulrich Kaiser, Irmgard Uebelacker, Ulrich Abel, Josef Birkmann, Lorenz Trumper, Harald Schmalenberg, Tunca Karakas, Bernd Metzner, Dieter K. Hossfeld, Helge G. Bischoff, Astrid Franke, Marcel Reiser, Peter Muller, Luisa Mantovani, Marc Grundeis, Frank Rothmann, Cay-Uwe von Seydewitz, Rolf M. Mesters, Ernst U. Steinhauer, Dorothea Krahl, Kurt Schumacher, Michael Kneba, Michael Baudis, Norbert Schmitz, Rudiger Pfab, Hubert Koppler, Reza Parwaresch, Michael Pfreundschuh, and Klaus Havemann Randomized Study to Evaluate the Use of High-Dose Therapy as Part of Primary Treatment for "Aggressive" Lymphoma J Clin Oncol 20: 4413-4419. Julie M. Vose, Graham Sharp, Wing C. Chan, Craig Nichols, Kevin Loh, David Inwards, Robert Rifkin, Philip J. Bierman, James C. Lynch, Dennis D. Weisenburger, Anne Kessinger, and James O. Armitage Autologous Transplantation for Aggressive Non-Hodgkin’s Lymphoma: Results of a Randomized Trial Evaluating Graft Source and Minimal Residual Disease J Clin Oncol 20: 2344-2352. -------------------------------------------------------------------------------Abstract 1 of 6 Journal of Clinical Oncology, Vol 21, Issue 7 (April), 2003: 1255-1262 © 2003 American Society for Clinical Oncology Early Autologous Stem-Cell Transplantation Versus Conventional Chemotherapy as Front-Line Therapy in High-Risk, Aggressive Non-Hodgkin’s Lymphoma: An Italian Multicenter Randomized Trial Maurizio Martelli, Filippo Gherlinzoni, Amalia De Renzo, Pier Luigi Zinzani, Antonio De Vivo, Maria Cantonetti, Brunangelo Falini, Sergio Storti, Giovanna Meloni, Manuela Rizzo, Anna Lia Molinari, Francesco Lauria, Luciano Moretti, Vito Michele Lauta, Patrizio Mazza, Luciano Guardigni, E. Pescarmona, S.A. Pileri, Franco Mandelli, Sante Tura From the Departments of Cellular Biotechnology and Hematology and Experimental Medicine and Pathology, University "La Sapienza" of Rome, Hematology University "Tor Vergata" Rome, and Division of Hematology "La Cattolica" University of Rome, Rome; Institute of Hematology and Medical Oncology, University of Bologna, Bologna; Division of Hematology, University of Napoli, Napoli; Hematology University of Perugia, Perugia; Division of Hematology, Ravenna Hospital, Ravenna; Division of Hematology, Pesaro Hospital, Pesaro; Division of Internal Medicine, University of Bari, Bari; Division of Hematology, Taranto Hospital, Taranto; and Division of Hematology, Cesena Hospital, Cesena; Italy. Address reprint requests to Maurizio Martelli, MD, Dipartimento Biotecnologie Cellulari ed Ematologia, University "La Sapienza" via Benevento, 6 00161 Roma, Italy; email: martelli@bce.med.uniroma1.it. Purpose: To evaluate the role of early intensification with high-dose therapy (HDT) and autologous stem-cell transplantation (ASCT) as front-line chemotherapy for patients with high-risk, histologically aggressive non-Hodgkin’s lymphoma (NHL). Patients and Methods: We planned a multicenter, randomized trial to compare a conventional chemotherapy regimen of methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B; arm A) with an abbreviated regimen of MACOP-B (8 weeks) followed by HDT and ASCT (arm B) for intermediate-high-risk/high-risk patients (according to the age-adjusted International Prognostic Index). From September 1994 to April 1998, 150 patients with aggressive lymphoma were enrolled onto the trial. Seventy-five patients were randomly assigned to arm A and 75 patients were randomly assigned to arm B. In both arms, involved-field radiation therapy (36 Gy) was delivered to the site of bulky disease. Results: The rate of complete response was 68% in arm A and 76% in arm B (P = not significant [NS]). Three toxic deaths (4%) occurred in arm B and one (1%) occurred in arm A (P = NS). In arm B, 30 patients (40%) did not undergo HDT and ASCT. According to the intention-to-treat analysis at a median follow-up of 24 months, 5-year overall survival probability in arms A and B was 65% and 64% (P = .95), 5-year progression-free survival was 49% and 61% (P = .21), and 5-year relapse-free survival was 65% and 77% (P = .22), respectively. Conclusion: Abbreviated chemotherapy followed by intensification with HDT-ASCT is not superior to conventional chemotherapy in patients with high-risk, aggressive NHL. Additional randomized trials will clarify whether HDT-ASCT as front-line therapy after a complete course of conventional chemotherapy improves survival in this group of patients. Supported by Ministero dell’ Università e Ricerca Scientifica (MURST) 40%. [Full Text of Martelli et al.] [Reprint (PDF) Version of Martelli et al.] -------------------------------------------------------------------------------Abstract 2 of 6 Journal of Clinical Oncology, Vol 20, Issue 10 (May), 2002: 2472-2479 © 2002 American Society for Clinical Oncology Shortened First-Line High-Dose Chemotherapy for Patients With Poor-Prognosis Aggressive Lymphoma By Christian Gisselbrecht, Eric Lepage, Thierry Molina, Bruno Quesnel, Georges Fillet, Pierre Lederlin, Bertrand Coiffier, Hervé Tilly, Jean Gabarre, Francoise Guilmin, Olivier Hermine, Félix Reyes for the Groupe d’Etude des Lymphomes de l’Adulte From the Institut d’Hématologie, GELA Hôpital Saint Louis; Service d’Anatomie Pathologique, Hôtel Dieu; Service d’Hématologie, Hôpital Pitié Salpétrière; Service d’Hématologie, Hôpital Necker, Paris; Departement d’Information Hospitalier, Hôpital Henri Mondor; Service d’Hématologie, Hôpital Henri Mondor, Créteil; Centre Hospitalier Universitaire de Lille, Lille; Service d’Hématologie et Medecine interne, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy; Centre Hospitalier Lyon Sud, Pierre Bénite; Centre Henri Becquerel, Rouen; Service d’Hématologie, Hôpital Beaujon, Clichy, France; and Centre Hospitalier Universitaire de Liège, Domaine Universitaire de Sart Tilman, Liège, Belgium. Address reprint requests to Christian Gisselbrecht, MD, Institut d’Hématologie, Hôpital SaintLouis, 1 avenue Claude Vellefaux, 75475 Paris cedex 10, France; email: christian.gisselbrecht@sls.ap-hop-paris.fr. PURPOSE: Randomized trial LNH93-3 was conducted on patients who had poor-prognosis aggressive lymphoma and were younger than 60 years with two to three factors of the age-adjusted International Prognostic Index to evaluate the benefit of early high-dose therapy (HDT) with autologous stem-cell transplantation (ASCT). PATIENTS AND METHODS: Patients were randomized between doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) chemotherapy followed by sequential consolidation and an experimental shortened treatment consisting of three cycles with escalated doses of cyclophosphamide, epirubicin, vindesine, bleomycin, and prednisone and collection of peripheral-blood stem cells. On day 60, HDT was administered with 1,3-bis(2-chloroethyl)-1nitrosourea, etoposide, cytarabine, and melphalan followed by ASCT. RESULTS: Eligible patients (n = 370) with aggressive lymphoma were analyzed. For ACVBP (181 patients) and HDT (189 patients), respective complete remission rates were 64% and 63%. With a median follow-up of 60 months, 5-year overall survival and event-free survival for ACVBP and HDT were 60% ± 8% and 46% ± 8% (P = .007) and 52 ± 8% and 39 ± 8% (P = .01), respectively. Survival was independently affected by age greater than 40 years (P = .0003), T-cell phenotype (P = .009), bone marrow involvement (P = .003), and HDT treatment group (P = .04). CONCLUSION: Early HDT with ASCT in high-risk patients was inferior to the ACVBP chemotherapy regimen. These results indicate that the received dose-intensity before HDT was too low when compared with ACVBP and HDT and was given too early. [Full Text of Gisselbrecht et al.] [Reprint (PDF) Version of Gisselbrecht et al.] -------------------------------------------------------------------------------Abstract 3 of 6 Journal of Clinical Oncology, Vol 19, Issue 2 (January), 2001: 406-413 © 2001 American Society for Clinical Oncology Autologous Transplantation for Diffuse Aggressive Non-Hodgkin’s Lymphoma in Patients Never Achieving Remission: A Report from the Autologous Blood and Marrow Transplant Registry By Julie M. Vose, Mei-Jie Zhang, Philip A. Rowlings, Hillard M. Lazarus, Brian J. Bolwell, Cesar O. Freytes, Santiago Pavlovsky, Armand Keating, Burhan Yanes, Koen van Besien, James O. Armitage, Mary M. Horowitz, Others of the Autologous Blood and Marrow Transplant Registry Lymphoma Working Committee From the Lymphoma Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI; University of Nebraska Medical Center, Omaha, NE; Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, The Cleveland Clinic Foundation, Cleveland, and Miami Valley Hospital, Dayton, OH; University of Texas Health Science Center at San Antonio, San Antonio, TX; Fundaleu Hospital, Buenos Aires, Argentina; Princess Margaret Hospital, Toronto, Ontario, Canada; and University of Illinois, Chicago, IL. Address reprint requests to Julie M. Vose, MD, Department of Internal Medicine, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680; email jmvose@unmc.edu. PURPOSE: To evaluate the results of high-dose chemotherapy and autologous hematopoietic stemcell transplantation (autotransplants) in patients with diffuse aggressive non-Hodgkin’s lymphoma (NHL) who never achieve a complete remission with conventional chemotherapy. PATIENTS AND METHODS: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 184 patients with diffuse aggressive NHL who never achieved a complete remission with conventional chemotherapy and subsequently received an autotransplant were evaluated. Transplants were performed between 1989 and 1995 and were reported to the ABMTR by 48 centers in North and South America. RESULTS: Seventy-nine (44%) of 184 patients achieved a complete remission or a complete remission with residual imaging abnormalities of unknown significance after autotransplantation. Thirty-four (19%) of 184 had a partial remission and 55 (31%) of 184 had no response or progressive disease. Eleven patients (6%) were not assessable for response because of early death. The probabilities of progression-free and overall survival at 5 years after transplantation were 31% (95% confidence interval [CI], 24% to 38%) and 37% (95% CI, 30% to 45%), respectively. In multivariate analysis, chemotherapy resistance, Karnofsky performance status score less than 80 at transplantation, age 55 years at transplantation, receiving three or more prior chemotherapy regimens, and not receiving pre- or posttransplant involved-field irradiation therapy were adverse prognostic factors for overall survival. CONCLUSION: High-dose chemotherapy and autologous hematopoietic stem-cell transplantation should be considered for patients with diffuse aggressive NHL who never achieve a complete remission but who are still chemotherapy-sensitive and are otherwise transplant candidates. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. For the names of the other authors on the ABMTR Lymphoma Working Committee, see the Appendix. [Full Text of Vose et al.] [Reprint (PDF) Version of Vose et al.] -------------------------------------------------------------------------------Abstract 4 of 6 Journal of Clinical Oncology, Vol 18, Issue 16 (August), 2000: 3025-3030 © 2000 American Society for Clinical Oncology Survival Benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Final Analysis of the Prospective LNH87–2 Protocol—A Groupe d’Etude des Lymphomes de l’Adulte Study By Corinne Haioun, Eric Lepage, Christian Gisselbrecht, Gilles Salles, Bertrand Coiffier, Pauline Brice, André Bosly, Pierre Morel, Christiane Nouvel, Hervé Tilly, Pierre Lederlin, Catherine Sebban, Josette Brière, Philippe Gaulard, Félix Reyes From the Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil; Hôpital Saint-Louis, AP-HP, Paris; Centre Hospitalier Lyon-Sud, Pierre Bénite; Centre Henri Becquerel, Rouen; Centre Hospitalier Huriez, Lille; Hôpital Purpan, Toulouse; Hôpitaux de Brabois, Nancy; Centre Léon Bérard, Lyon, France; and Cliniques Universitaires de Mont Godinne, Yvoir, Belgium. Address reprint requests to Corinne Haioun, MD, Service d’Hématologie Clinique, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; email corinne .haioun@hmn.ap-hop-paris.fr. PURPOSE: To present the final analysis, with a median follow-up of 8 years, of the LNH87–2 randomized study, which compares consolidative sequential chemotherapy (ifosfamide plus etoposide, asparaginase, and cytarabine) with high-dose therapy (HDT) using cyclophosphamide, carmustine, and etoposide (CBV regimen) followed by stem-cell transplantation in patients with aggressive non-Hodgkin’s lymphoma in first complete remission after induction, focusing on high/intermediate- and high-risk patients identified by the age-adjusted international prognostic index. PATIENTS AND METHODS: Among the 916 eligible patients, 451 presented with two (n = 318) or three (n = 133) risk factors. After reaching complete remission to induction therapy, 236 of these higher risk patients were assessable for the consolidation phase, with 125 patients in the HDT arm and 111 in the sequential chemotherapy arm. RESULTS: Among these 451 higher risk patients, 277 (61%) achieved complete remission after induction treatment. In the population of 236 randomized patients, HDT was superior to sequential chemotherapy, with 8-year disease-free survival rates of 55% (95% confidence interval [CI], 46% to 64%) and 39% (95% CI, 30% to 48%), respectively (P = .02; relative risk, 1.56). The 8-year survival rate was significantly superior in the HDT arm (64%; 95% CI, 55% to 73%) compared with the sequential chemotherapy arm (49%; 95% CI, 39% to 59%) (P = .04; relative risk, 1.51). CONCLUSION: On the basis of the final analysis of this prospectively treated series of patients, retrospectively analyzed on the basis of the International Prognostic Index, we hypothesize that HDT benefits patients at higher risk who achieve complete remission after induction treatment. [Full Text of Haioun et al.] [Reprint (PDF) Version of Haioun et al.] -------------------------------------------------------------------------------Abstract 5 of 6 Journal of Clinical Oncology, Vol 20, Issue 22 (November), 2002: 4413-4419 © 2002 American Society for Clinical Oncology Randomized Study to Evaluate the Use of High-Dose Therapy as Part of Primary Treatment for "Aggressive" Lymphoma Ulrich Kaiser, Irmgard Uebelacker, Ulrich Abel, Josef Birkmann, Lorenz Trumper, Harald Schmalenberg, Tunca Karakas, Bernd Metzner, Dieter K. Hossfeld, Helge G. Bischoff, Astrid Franke, Marcel Reiser, Peter Muller, Luisa Mantovani, Marc Grundeis, Frank Rothmann, Cay-Uwe von Seydewitz, Rolf M. Mesters, Ernst U. Steinhauer, Dorothea Krahl, Kurt Schumacher, Michael Kneba, Michael Baudis, Norbert Schmitz, Rudiger Pfab, Hubert Koppler, Reza Parwaresch, Michael Pfreundschuh, Klaus Havemann From the Departments of Hematology and Oncology, Universitätsklinikum Marburg, Klinikum Nürnberg, Universitätsklinikum Homburg, Universitätsklinikum Jena, Universitätsklinikum Ulm, Klinikum Oldenburg, Universitätsklinikum Hamburg, Thoraxklinik Heidelberg-Rohrbach, Universitätsklinikum Magdeburg, Universitätsklinikum Köln, Zentralklinikum Augsburg, Universitätsklinikum Leipzig, Universitätsklinikum Leipzig, Klinikum Chemnitz, Klinikum Potsdam, Krankenhaus Hamburg-Altona, Universitätsklinikum Münster, Klinikum Kassel, Humboldt-Universität Berlin, Robert-Bosch Krankenhaus Stuttgart, Universitätsklinikum Göttingen, Universitätsklinikum Heidelberg, Universitätsklinikum Kiel, Klinikum Minden, Universitätsklinikum Rostock, Universitätsklinikum Zürich, Klinikum Karlsruhe, Klinikum Hagen, Klinikum Herford, Klinikum Lemgo, Universitätsklinikum Lund, Klinikum Mönchengladbach, Universitätsklinikum Uppsala, Universitätsklinikum Aachen, Diakonissenkrankenhaus Bremen, Klinikum Cottbus, Klinikum Darmstadt, Klinikum Eschweiler, Diakoniekrankenhaus Freiburg, Klinikum Münchberg, Klinikum Schwenningen, Klinikum Schweinfurt, Klinikum Trier, and Klinikum Wolfsburg; the Institute of Medical Statistics, Universität Heidelberg; and the Institute of Hematopathology, Universität Kiel, Germany. Address reprint requests to Ulrich Kaiser, MD, St Bernward Krankenhaus, Klinik für Hämatologie, Onkologie und Immunologie, Treibestrasse 9, D-31134 Hildesheim, Germany; email: pd.dr.u.kaiser@bernward-khs.de. PURPOSE: This trial of the German High-Grade Non-Hodgkin’s Lymphoma Study Group compares the use of high-dose therapy (HDT) as part of primary treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide followed by involved-field (IF) radiotherapy in a randomized, multicenter, phase III study. PATIENTS AND METHODS: Three hundred twelve patients with "aggressive" non-Hodgkin’s lymphoma aged 60 years with elevated serum lactate dehydrogenase levels were included from 1990 to 1997. Patients with at least a minor response after two cycles of CHOEP (CHOP + etoposide 3 x 100 mg/m2) were to receive three further cycles of CHOEP followed by IF radiotherapy (arm A) or one further cycle of CHOEP followed by autologous stem-cell transplantation and IF radiotherapy (arm B). RESULTS: Among 158 patients randomized to arm B, 103 (65%) received HDT. The complete remission rate at the end of treatment was 62.9% in arm A and 69.9% in arm B. With a median observation time of 45.5 months, overall survival for all 312 patients was 63% after 3 years (63% for arm A, 62% for arm B; P = .68). Event-free survival was 49% for arm A versus 59% for arm B (P = .22). Relapse in arm B was associated with a significantly worse survival rate than relapse in arm A (P < .05). Relapse after HDT occurred early (median interval, 3 months). Six patients developed secondary neoplasia, three in arm A and three in arm B. CONCLUSION: Results of the randomized trial comparing CHOP-like chemotherapy with early HDT do not support the use of HDT with carmustine, etoposide, cytarabine, and melphalan following shortened standard chemotherapy. [Full Text of Kaiser et al.] [Reprint (PDF) Version of Kaiser et al.] -------------------------------------------------------------------------------Abstract 6 of 6 Journal of Clinical Oncology, Vol 20, Issue 9 (May), 2002: 2344-2352 © 2002 American Society for Clinical Oncology Autologous Transplantation for Aggressive Non-Hodgkin’s Lymphoma: Results of a Randomized Trial Evaluating Graft Source and Minimal Residual Disease By Julie M. Vose, Graham Sharp, Wing C. Chan, Craig Nichols, Kevin Loh, David Inwards, Robert Rifkin, Philip J. Bierman, James C. Lynch, Dennis D. Weisenburger, Anne Kessinger, James O. Armitage From the Departments of Internal Medicine, Anatomy and Cell Biology, Pathology and Microbiology, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE; Indiana University Medical Center, Indianapolis, IN; Queens Medical Center, Honolulu, HI; Mayo Clinic, Rochester, MN; and Rocky Mountain Cancer Center, Denver, CO. Address reprint requests to Julie M. Vose, MD, Department of Internal Medicine, Section of Hematology/Oncology, University of Nebraska Medical Center, 600 S 42nd St, Omaha, NE 69198; email: jmvose@unmc.edu. PURPOSE: To determine whether the source of autologous hematopoietic stem cells altered the clinical outcomes of patients undergoing high-dose chemotherapy and hematopoietic stem-cell transplantation (HSCT) for aggressive non-Hodgkin’s lymphoma (NHL). PATIENTS AND METHODS: Of 105 high-risk, persistent, or relapsed NHL patients slated for an autologous HSCT entered onto this trial, 93 eligible patients were randomized to receive cytokinenaive autologous bone marrow transplantation (ABMT) (n = 46) or mobilized peripheral-blood stem-cell transplantation (PBSCT) (n = 47). All patients received carmustine, etoposide, cytarabine, and cyclophosphamide as the conditioning regimen. PBSCT patients also received identical mobilization with granulocyte colony-stimulating factor (G-CSF) 10 µg/kg/d, and both groups received G-CSF 5 µg/kg/d after the infusion of the stem-cell product until neutrophil engraftment. RESULTS: PBSCT patients had significantly faster engraftment of all cell lineages: median time to absolute neutrophil count 500/µL, 10 days versus 13 days on the ABMT arm; median time to platelet count greater than 20,000/µL untransfused, 11 days versus 15 days on the ABMT arm; and median time to RBC transfusion independence, 8 days versus 16 days on the ABMT arm. The complete response rate was 72% for PBSCT and 54% for ABMT. The death rate before posttransplant day 100 was 2% on the ABMT arm and 6% on PBSCT arm. Event-free survival was 37% for PBSCT and 37% for ABMT. However, overall survival for PBSCT was 61% compared with 43% for ABMT. CONCLUSION: Patients with aggressive NHL receiving HSCT randomized to PBSCT demonstrated improved neutrophil engraftment and platelet and RBC transfusion independence. The complete response rate and EFS were not statistically different by randomization arm. Patients whose harvests were positive for minimal residual disease by molecular analysis had poorer EFS. [Full Text of Vose et al.] [Reprint (PDF) Version of Vose et al.] -------------------------------------------------------------------------------HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH SEARCH RESULT © 2003 American Society of Clinical Oncology. International Consensus Conference on High-Dose Therapy With Hematopoietic Stem Cell Transplantation in Aggressive Non-Hodgkin's Lymphomas: Report of the Jury M.A. Shipp, M.D. Abeloff, K.H. Antman, G. Carroll, A. Hagenbeek, M. Loeffler, E. Montserrat, J.A. Radford, G. Salles, N. Schmitz, M. Symann, J.O. Armitage, T. Philip, and B. Coiffier JCO Jan 1 1999: 423. [Full Text] [PDF] High-Dose Therapy and Autologous Stem-Cell Transplantation Versus Conventional-Dose Consolidation/Maintenance Therapy as Postremission Therapy for Adult Patients With Lymphoblastic Lymphoma: Results of a Randomized Trial of the European Group for Blood and Marrow Transplantation and the United Kingdom Lymphoma Group John W. Sweetenham, Gino Santini, Wendi Qian, Monica Guelfi, Norbert Schmitz, Sarah Simnett, Arnon Nagler, Harald Holte, Stein Kvaloy, Paulo Bruzzi, and Anthony H. Goldstone JCO Jun 1 2001: 2927-2936. [Abstract] [Full Text] [PDF] Survival Benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Concerns About Omissions in the Data Presented R.D. Kennedy, R.G. Cuthbert, P.J. Kettle, T.C.M. Morris Queens University of BelfastBelfast City HospitalBelfast, Northern Ireland To the Editor:We find the results from the LNH87-2 study published in the August 2000 issue of the Journal of Clinical Oncology1 interesting, but we have some concerns regarding the data. First, we noted that two different induction regimens were used until 4 years into enrollment. One regimen used mitoxantrone and this was believed to be inferior to a doxorubicin-containing regimen. In the patients who proceeded to consolidation therapy, the authors have not demonstrated that the high-dose group and sequential chemotherapy groups were balanced with regard to induction. Our concern is that one group may have received a significantly inferior induction treatment. Second, the authors do not explain why 31% of the group randomized to receive high-dose treatment did not receive it. Although this would not influence the survival and relapse figures, since the data were analyzed on an intent-to-treat basis, it would influence the toxicity figures. Perhaps patients who would have suffered toxicity from the high-dose procedure were removed from the trial at this stage. The article also does not state the time between induction and transplantation in the high-dose arm. This could have a bearing on the outcome, as the 69% who proceeded to treatment may have been a self-selecting, good-prognosis group. Third, we would like to have seen the overall survival figure for the 41 patients who did not receive consolidation treatment. There is a suggestion from the disease-free survival figure of 51% that this group may have had as good an outcome as the consolidative chemotherapy groups (although we accept that the numbers in the no-consolidation group were low). We find this trial encouraging and believe it highlights the need for further randomized clinical trials designed to identify the subgroups of high-grade non-Hodgkin’s lymphoma that may benefit from high-dose chemotherapy and autologous transplantation. REFERENCES 1. Haioun C, Lepage E, Gisselbrecht C, et al: Survival benefit of high-dose therapy in poorrisk aggressive non-Hodgkin’s lymphoma: Final analysis of the prospective LNH87-2 protocol—A Groupe d’Etude des Lymphomes de l’Adulte study. J Clin Oncol 18: 30253030, 2000[Abstract/Free Full Text] High-dose chemotherapy followed by autologous bone marrow transplantation versus dexamethasone, cisplatin, and cytarabine in aggressive non-Hodgkin's lymphoma with partial response to front-line chemotherapy: a prospective randomized italian multicenter study M Martelli, M Vignetti, PL Zinzani, F Gherlinzoni, G Meloni, M Fiacchini, V De Sanctis, G Papa, MF Martelli, F Calabresi, S Tura, and F Mandelli JCO Feb 1 1996: 534-542. Benefit of autologous bone marrow transplantation over sequential chemotherapy in poor-risk aggressive nonHodgkin's lymphoma: updated results of the prospective study LNH87-2. Groupe d'Etude des Lymphomes de l'Adulte C Haioun, E Lepage, C Gisselbrecht, Y Bastion, B Coiffier, P Brice, A Bosly, B Dupriez, C Nouvel, H Tilly, P Lederlin, P Biron, J Briere, P Gaulard and F Reyes Hopital Henri Mondor, Creteil, France. corinne.haioun@hmn.ap-hop- paris.fr PURPOSE: To update the randomized study that compared consolidative sequential treatment (ifosfamide, etoposide, asporaginase, and cytarabine) versus the high-dose regimen of cyclophosphamide, carmustine, and etoposide (CBV) followed by autotransplantation in patients with aggressive non-Hodgkin's lymphoma in first complete remission and to focus on highintermediate and high-risk patients identified by the international prognostic index. PATIENTS AND METHODS: Nine hundred sixteen patients received induction treatment on the LNH84 protocol with open randomization for the anthracycline. In a subsequent randomization, 541 patients in complete remission were assigned to receive consolidation by either sequential chemotherapy (n = 273) or autotransplant (n = 268). Among the higher risk population (two or three risk factors), 236 patients in complete remission were assessable for the consolidation phase, with 111 in the sequential chemotherapy arm and 125 in the autotransplant arm. RESULTS: Among 541 randomized patients, disease-free survival and survival did not differ significantly between the two consolidative treatment arms. In the higher risk population, CBV was superior to sequential chemotherapy, with 5-year disease-free survival rates of 59% (95% confidence interval, 49% to 69%) and 39% (95% confidence interval, 28% to 50%), respectively (P = .01, relative risk = 1.19). The 5-year survival rate was superior in the CBV group at 65% (95% confidence interval, 56% to 74%) compared with 52% in the sequential chemotherapy group (95% confidence interval, 42% to 62%) (P = .06, relative risk = 1.49). CONCLUSION: This study shows a superior disease-free survival for higher risk patients in complete remission. Dose-intensive consolidation therapy should be considered for patients at higher risk who achieve complete remission after induction treatment. Comparison of autologous bone marrow transplantation with sequential chemotherapy for intermediate-grade and highgrade non-Hodgkin's lymphoma in first complete remission: a study of 464 patients. Groupe d'Etude des Lymphomes de l'Adulte C Haioun, E Lepage, C Gisselbrecht, B Coiffier, A Bosly, H Tilly, P Morel, C Nouvel, R Herbrecht and MF D'Agay Hopital Henri Mondor, Creteil, France. PURPOSE: Intensive chemotherapy followed by autotransplantation has given promising results in partially responding or sensitive relapsed patients with aggressive non-Hodgkin's lymphoma. In 1987, we designed a randomized study to evaluate the potential benefit of a high-dose regimen containing cyclophosphamide, carmustine, and etoposide (CBV) followed by autotransplantation over a consolidative sequential chemotherapy (ifosfamide, etoposide, asparaginase, and cytarabine) in patients in first complete remission with intermediate- and high-grade non-Hodgkin's lymphoma. PATIENTS AND METHODS: Patients were younger than 55 years and had at least one adverse prognostic factor. Induction treatment was that of the LNH84 protocol with an open randomization on the anthracycline. Patients in complete remission were further randomly assigned to receive either consolidation procedure. RESULTS: After induction treatment, 464 patients were assessable for the consolidation phase. With a median follow-up duration of 28 months, the 3-year disease-free survival rate was 52% (95% confidence interval, 45% to 59%) in the sequential chemotherapy arm and 59% (95% confidence interval, 52% to 66%) in the autologous transplant arm (P = .46, relative risk = 0.90). The 3-year survival rate did not differ between sequential chemotherapy and autotransplantation, at 71% (95% confidence interval, 64% to 78%) and 69% (95% confidence interval, 62% to 76%), respectively (P = .60, relative risk = 1.11). CONCLUSION: For such a subset of patients, consolidation with the CBV regimen followed by autologous bone marrow transplantation is not superior to sequential chemotherapy. 1: Shimoni A, Hardan I, Avigdor A, Yeshurun M, Raanani P, Ben-Bassat I, Nagler A. Related Articles, Links Rituximab reduces relapse risk after allogeneic and autologous stem cell transplantation in patients with high-risk aggressive non-Hodgkin's lymphoma. Br J Haematol. 2003 Aug;122(3):457-64. 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Related Articles, Links [High dose chemotherapy followed by hematopoietic stem cell transplantation for malignant lymphoma] Gan To Kagaku Ryoho. 1995 Oct;22(12):1724-30. Review. Japanese. PMID: 7574802 [PubMed - indexed for MEDLINE] 402: Gerhartz HH. Related Articles, Links Perspective of rhGM-CSF in the treatment of neutropenic infections and aggressive lymphomas. Stem Cells. 1995 Sep;13(5):472-6. Review. PMID: 8528096 [PubMed - indexed for MEDLINE] 403: Murphy WJ, Funakoshi S, Beckwith M, Rushing SE, Conley DK, Armitage RJ, Fanslow WC, Rager HC, Taub DD, Ruscetti FW, et al. Related Articles, Links Antibodies to CD40 prevent Epstein-Barr virus-mediated human B-cell lymphomagenesis in severe combined immune deficient mice given human peripheral blood lymphocytes. Blood. 1995 Sep 1;86(5):1946-53. PMID: 7544649 [PubMed - indexed for MEDLINE] 404: Fermand JP, Ravaud P, Chevret S, Leblond V, Divine M, Dreyfus F, Belanger C, Troussard X, Mariette X, Brouet JC. 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Related Articles, Links Cancer following renal transplantation. Aust N Z J Surg. 1979 Dec;49(6):617-20. PMID: 393229 [PubMed - indexed for MEDLINE] Summary Brief Abstract Citation ASN.1 MEDLINE XML UI List LinkOut Related Articles Domain Links 3D Domain Links GEO DataSet Links Genome Links GEO Links Nucleotide Links OMIM Links PMC Links Cited in PMC PopSet Links Protein Links SNP Links Structure Links Show: 5 10 20 50 100 200 500 Sort Author Journal Pub Date Text File Clipboard E-mail Order Items 401-562 of 562 Previous of 3 Write to the Help Desk NCBI | NLM | NIH Department of Health & Human Services Freedom of Information Act | Disclaimer Jul 17 2003 11:42:11