Autologous
stem cell transplantation (ASCT) in the front line treatment of
non-Hodgkin's lymphoma (NHL) remains controversial.
Anaplastic large-cell lymphoma (ALCL) is known to have its own clinical and
biological features. The outcome of ALCL patients treated with high-dose
chemotherapy and ASCT as part of their first-line
therapy was analysed in 202 intermediate or high-grade NHL patients in a prospective randomized trial. First-line
chemotherapy comprised two alternating
anthracycline-containing regimens. Responding patients were autografted after a BEAM (
BCNU,
cytarabine,
etoposide and
melphalan) regimen. Patients with bulky or residual masses were irradiated. Fifteen patients with ALCL were identified by morphological and immunological features (CD30 was expressed in 14 out of 15 patients, three patients expressed B-cell markers, five patients expressed T-cell markers and seven patients did not express cell markers).
Anaplastic lymphoma kinase (ALK) expression was confirmed in seven cases. The median age was 39 years with a predominant male sex ratio (2.75). Thirteen patients were stage >/= III and six presented with two or more adverse prognostic factors. According to the international age-adjusted prognostic index, the expected complete remission (CR), event-free survival (EFS) and overall survival (OS) rates were 69%, 71% and 69%. Two deaths were observed (one due to
interstitial pneumonitis, one due to pulmonary
carcinoma). All patients entered CR, no relapse occurred and EFS and survival reached 87% with a follow-up of more than 5 years. These results differ significantly from those observed in the other 176
lymphoma patients: event-free survival was only 53 +/- 5% and OS reached 60 +/- 4% with a median follow-up of 56 months (P = 0.006). Intensified
chemotherapy with autologous stem cell support appeared effective in the treatment of ALCL, offering patients the real chance of a cure.