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Blood, Vol. 92 No. 10 (November 15), 1998:
pp. 3562-3568
The International Prognostic Index Correlates to Survival in
Patients With Aggressive Lymphoma in Relapse: Analysis of the PARMA
Trial
J.-Y. Blay,
F. Gomez,
C. Sebban,
T. Bachelot,
P. Biron,
C. Guglielmi,
A. Hagenbeek,
R. Somers,
F. Chauvin, and
T. Philip on
behalf of the PARMA Group
From the PARMA Cooperative Group (with Fédération
Nationale des Centres de Lutte Contre le Cancer [FNCLCC], Dutch
Haemato-Oncology Working Party [HOVON], European Organization for
Research and Treatment of Cancer [EORTC], Groupe d'Etude des
Lymphomes Adultes [GELA], and non-Hodgkin's Lymphoma Italian
Groups); Centre Léon Bérard, Lyon, France; Dipartimento Di
Biotecnologie Cellulari ed Ematologia, Università "La
Sapeinza," Roma, Italy; the University Hospital Rotterdam, Daniel
Den Hoed Cancer Center, Department of Hematology, Rotterdam, The
Netherlands; and University Hospital Utrecht, Department of Hematology,
Utrecht, The Netherlands; Antonie Van Leeuwenhoek Huis, The Netherlands
Cancer Center Institute, Internal Medicine Department, Amsterdam, The
Netherlands; and the Academic Medical Center, Internal Medicine
Department, Amsterdam, The Netherlands.
The objectives of the present study were to investigate the
prognostic value of the International Prognostic Index (IPI) at relapse
in the 215 patients with intermediate- or high-grade non-Hodgkin's lymphoma (NHL) included in the PARMA trial. The IPI at relapse was
available in 204 (95%) of these patients. Response rates to 2 courses
of DHAP were 77%, 54%, 55%, and 42% in patients with an IPI of 0, 1, 2 and 3, respectively (P < .02), whereas complete response
(CR) rates were 33%, 29%, 20%, and 0% in the same groups of
patients (P < .03). With a median follow-up period of 79 months, overall survival (OS) at 5 years was 46%, 25%, 25%, and 11%
in these four groups (P < .001). One hundred nine patients
responding to 2 courses of DHAP were randomized to receive either BEAC
(carmustine, etoposide, cytarabine, cyclophosphamide and mesna)
followed by autologous bone marrow transplantation (ABMT)
or 4 additional courses of DHAP: IPI at relapse was found highly
correlated to OS in patients treated in the DHAP arm (5-year OS: 48%,
21%, 33%, and 0% for IPI 0, 1, 2, and 3, respectively; P = .006), but not in the BEAC arm (5-year OS: 51%, 47%, 50%, and 50%
for IPI 0, 1, 2, and 3, respectively; P = .90). OS was
significantly superior in the BEAC arm as compared with the DHAP arm in
patients with an IPI >0 (P < .05), but not in patients with
an IPI of 0. In conclusion, these results show that IPI correlates to
response and overall survival in patients with aggressive NHL in
relapse and enables us to identify patients with a significantly
different outcome among those treated with conventional chemotherapy
alone.
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