Clinical outcome after autologous transplantation in non-Hodgkin's lymphoma patients with high international prognostic index (IPI).
BACKGROUND
Dose intensification and autologous stem cell transplantation as front-line therapy in non-Hodgkin's lymphoma patients (NHL) is a matter for debate, although preliminary data suggest a role for it in patients at high risk of resistance or relapse according to the international prognostic index (IPI). PURPOSE AND STUDY DESIGN: To compare retrospectively the clinical outcome of two cohorts of NHL patients with high-risk IPI treated with MACOP-B for 12 weeks (38 patients) or high-dose chemotherapy (44 patients) including eight weeks of MACOP-B, one or two intensification cycles with mitoxanthrone, dexamethasone, high-dose ara-C and finally BEAM chemotherapy with autologous hemopoietic progenitor cell transplantation.


RESULTS
The actuarial estimate of event (progression, relapse or death)-free survival (EFS) at three years was better (58% vs. 41%, P = 0.08) for patients treated with intensive regimen even though the overall survival did not show a statistically significant difference (63% vs. 50%, P = 0.27). Multivariate analysis showed that the high-dose chemotherapy program was the only independent variable correlating with a reduction in the event rate.


CONCLUSIONS
Early autologous stem-cell transplantation might improve the clinical outcome of high-risk patients according to IPI.
Cortelazzo
S
S
Division of Hematology, Ospedali Riuniti di Bergamo, Italy. ematologia@cyberg.it
Rossi
A
A
Bellavita
P
P
Oldani
E
E
Viero
P
P
Buelli
M
M
Rambaldi
A
A
Barbui
T
T
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome