title: Clinical outcome after front-line intensive sequential chemotherapy (ISC) in patients with aggressive non-Hodgkin's lymphoma and high-risk international prognostic index (IPI 3): final analysis of survival in two consecutive ISC trials.
abstract: BACKGROUND
  Aggressive non-Hodgkin's lymphomas (NHL) in patients under the age of 60 have a very poor prognosis when the international prognostic index (IPI) is high, with an age-adjusted (Aa)-IPI score at 3. In such patients, conventional chemotherapy results in a low complete response (CR) rate of 46%, a five-year survival and disease-free survival (DFS) of 32% and 58%, respectively. For this report we have analyzed whether front-line high-dose chemotherapy could influence the outcome of this group of patients.
  
  
  METHODS
  From 1992 onwards we conducted two pilot clinical trials of intensive sequential chemotherapy (ISC) with growth factors and blood stem cell support as initial treatment in 62 poor-risk patients with aggressive NHL. Of these patients, 33 were considered to be a high-risk group based on the Aa-IPI.
  
  
  RESULTS
  The median age was 42 years (range 21-60). The treatment was completed in 88% of patients, 86% receiving greater than 75% or more of the projected dose-intensity. Twenty patients (61%) achieved a CR. At a median follow-up of 48 months (range 26-86), the estimated five-year survival and DFS was 51% (95% confidence interval (CI): 34%-68%) and 70% (95% CI: 50%-90%), respectively.
  
  
  CONCLUSIONS
  These results suggest that primary treatment using high-dose therapy supported by both growth factors and peripheral blood stem cells can cure up to 50% of high-risk patients with malignant lymphomas.
authors.affiliation: Department of Hematology, Institut Paoli-Calmettes, Regional Cancer Center-Université de la Méditerranée, Marseille, France. hematol@marseille.fnclcc.fr
authors.forename: R
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: A M
authors.initials: AM
authors.lastname: Stoppa
authors.forename: D
authors.initials: D
authors.lastname: Coso
authors.forename: V J
authors.initials: VJ
authors.lastname: Bardou
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.forename: C
authors.initials: C
authors.lastname: Chabannon
authors.forename: J A
authors.initials: JA
authors.lastname: Gastaut
authors.forename: D
authors.initials: D
authors.lastname: Maraninchi
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006133:Growth Substances / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006133:Growth Substances; D016179:Granulocyte Colony-Stimulating Factor