title: Intensive chemotherapy with hematopoietic cell transplantation after ESHAP therapy for relapsed or refractory non-Hodgkin's lymphoma. Results of a single-centre study of 65 patients.
abstract: This study was designed to assess the results of protracted courses of ESHAP (etoposide, cytarabine, cisplatin, methylprednisolone) therapy followed by intensive chemotherapy and hematopoietic cell transplantation (IC+HCT) for relapsed or refractory non-Hodgkin's lymphoma (NHL). Treatment consisted of 3 cycles of ESHAP; responsive patients (pts) then received 3 more cycles, and IC+HCT was used for pts in maintained partial (PR) or complete (CR) remission after the sixth ESHAP. Sixty-five pts entered the study. At enrollment, 27 pts had bone marrow (BM) and/or central nervous system (CNS) lymphomatous infiltration. Disease status was primary refractory lymphoma in 41 pts (63 %), and relapse in 24 pts (37 %). Results showed that two pts were not evaluable for the therapeutic response because of early treatment-related death. Thirty-nine (62 %) pts entered PR or CR after 3 cycles of ESHAP. Eleven pts subsequently had disease progression. Twenty-eight pts were in persistent CR or PR after 6 cycles of ESHAP. Refractory pts did not show a different response rate to relapsing pts (chi2= 1.73). Five pts were excluded from IC+HCT because of an inadequate graft or treatment-related toxicity. Twenty-three (35 %) pts completed the procedure. Five pts (22 %) relapsed after IC+HCT. The overall survival rate of the 39 responsive pts is 45 % at 60 months, with a median survival time of 30 months. Median survival among the 35 pts in whom second-line chemotherapy failed is 7.1 months, with a 4-year survival rate of 3 %. Despite the poor prognostic features of this group, 45% of pts responding to the first 3 cycles of chemotherapy are in prolonged remission, suggesting that rather than to transplant after just 2 cycles of salvage therapy, pursuing second-line chemotherapy may better discriminate between patients more likely to benefit from a subsequent transplant.
authors.affiliation: Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Soussain
authors.forename: B
authors.initials: B
authors.lastname: Souleau
authors.forename: J
authors.initials: J
authors.lastname: Gabarre
authors.forename: H
authors.initials: H
authors.lastname: Zouabi
authors.forename: L
authors.initials: L
authors.lastname: Sutton
authors.forename: C
authors.initials: C
authors.lastname: Boccaccio
authors.forename: N
authors.initials: N
authors.lastname: Albin
authors.forename: F
authors.initials: F
authors.lastname: Charlotte
authors.forename: H
authors.initials: H
authors.lastname: Merle-Béral
authors.forename: J
authors.initials: J
authors.lastname: Delort
authors.forename: J L
authors.initials: JL
authors.lastname: Binet
authors.forename: V
authors.initials: V
authors.lastname: Leblond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone