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.

Abstract

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.

• Authors: C Haioun, E Lepage, C Gisselbrecht, G Salles, B Coiffier, P Brice, A Bosly, P Morel, C Nouvel, H Tilly, P Lederlin, C Sebban, J Brière, P Gaulard, F Reyes
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 18 Issue 16 Pg. 3025-30 (Aug 2000) ISSN: 0732-183X [Print] United States
• PMID: 10944137 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antibiotics, Antineoplastic
• Bleomycin
• Etoposide
• Cyclophosphamide
• Vindesine
• Carmustine
• Methylprednisolone
• Methotrexate

Topics

• Adult
• Age Factors
• Antibiotics, Antineoplastic (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bleomycin (administration & dosage)
• Bone Marrow Transplantation
• Carmustine (administration & dosage)
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Disease-Free Survival
• Etoposide (administration & dosage)
• Female
• Humans
• Lymphoma, Non-Hodgkin (drug therapy, therapy)
• Male
• Methotrexate (administration & dosage)
• Methylprednisolone (administration & dosage)
• Prognosis
• Prospective Studies
• Remission Induction
• Risk Factors
• Statistics, Nonparametric
• Vindesine (administration & dosage)