title: The International Prognostic Index predicts for outcome following autologous stem cell transplantation in patients with relapsed and primary refractory intermediate-grade lymphoma.
abstract: We analyzed a group of 51 patients with primary refractory and relapsed intermediate-grade lymphoma (IGL) from the time of initiation of three cycles of second-line chemotherapy, ifosfamide, carboplatin and etoposide (ICE), in whom the intent was to administer curative high-dose chemoradiotherapy and autologous stem cell transplantation (ASCT). We sought to determine if the International Prognostic Index (IPI) assessed immediately prior to ICE, second-line IPI (sIPI), was predictive of outcome. The response rate to ICE-based chemotherapy was 69%, and 47% of the transplanted patients remain failure-free at 2.5 years. Stratification of patients based upon the sIPI demonstrated a superior 2.5 year failure-free survival (FFS) curve for patients with low (I) or low-intermediate (II) risk disease vs. those with high-intermediate (III) and high (IV) risk disease (45% vs. 9%, P<0.001). When the analysis was restricted to those patients with chemosensitive disease, the sIPI (I/II vs. III/IV) also separated patients into two distinct prognostic groups (59% vs. 20%, P = 0.04). Patients with sIPI I and II disease have a favorable outcome with ICE chemotherapy and ASCT. However, patients with sIPI III and IV disease derive limited benefit from this treatment strategy, and new approaches are needed in this patient group.
authors.affiliation: Department of Medicine, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: S D
authors.initials: SD
authors.lastname: Nimer
authors.forename: J R
authors.initials: JR
authors.lastname: Glassman
authors.forename: C S
authors.initials: CS
authors.lastname: Portlock
authors.forename: J
authors.initials: J
authors.lastname: Yahalom
authors.forename: D J
authors.initials: DJ
authors.lastname: Straus
authors.forename: J P
authors.initials: JP
authors.lastname: O'Brien
authors.forename: N
authors.initials: N
authors.lastname: Elkin
authors.forename: J R
authors.initials: JR
authors.lastname: Bertino
authors.forename: A D
authors.initials: AD
authors.lastname: Zelenetz
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005047:Etoposide / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide