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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
ICE-chemosensitive 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.
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