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Blood, 15 June 2006, Vol. 107, No. 12, pp. 4623-4627.
Prepublished online as a Blood First Edition Paper on February 7, 2006; DOI 10.1182/blood-2005-12-4898.


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Submitted December 9, 2005
Accepted January 30, 2006

Upfront double high dose chemotherapy with DICEP followed by beam and autologous stem cell transplantation for poor prognosis aggressive non-Hodgkin's lymphoma

Douglas A Stewart*, Nizar Bahlis, Karen Valentine, Alex Balogh, Lynn Savoie, Donald G Morris, Allan Jones, Chris Brown, and James A Russell

Departments of Medicine and Oncology, University of Calgary, Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alberta, Canada

* Corresponding author; email: douglast{at}cancerboard.ab.ca.

A single centre, prospective clinical trial was conducted evaluating two cycles of induction high dose chemotherapy for adults less than 65 years of age with aggressive non-Hodgkin's lymphoma (NHL) and 2-3 Age-Adjusted International Prognostic Index risk factors. Patients received one cycle of standard dose CHOP followed by one cycle of dose-intensive cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2, cisplatin 105 mg/m2 (DICEP), then underwent autologous blood stem cell collection, followed by one cycle of high dose BCNU 300 mg/m2, etoposide 800 mg/m2, Ara-C 1600 mg/m2, melphalan 140 mg/m2, (BEAM) and autologous stem cell transplantation (ASCT) and radiotherapy to prior bulk. From June 1998 to August 2004, 55 patients aged 20-63 years (median 44) were accrued, 51 (92%) of whom had diffuse large B-cell NHL. Poor prognostic factors included stage 4 (n=46), elevated LDH (n=47), ECOG performance status 2-4 (n=43), bulky mass >10cm (n=34), marrow involvement (n=16). Only one patient experienced non-relapse mortality. With a median follow up of 49 months, 4 year event free (EFS) and overall survival (OS) rates for all 55 patients are 72% (95% CI=60-84%) and 79% (95% CI=69-90%), respectively. In conclusion, CHOP-DICEP-BEAM is feasible and gave encouraging EFS and OS for patients with poor prognosis aggressive NHL.


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