title: Conventional second-line salvage chemotherapy regimens are not warranted in patients with malignant lymphomas who have progressive disease after first-line salvage therapy regimens.
abstract: This study aimed to determine the outcome of patients with relapsed or refractory lymphoma who have an inadequate response to first-line salvage therapy (1 degrees ST) and who subsequently receive a second-line salvage regimen (2 degrees ST) with the intention of ultimately proceeding to high-dose therapy. The outcome of 57 patients [Hodgkin's Lymphoma 17, histologically-aggressive non-Hodgkin's Lymphoma (NHL) 26, histologically-indolent NHL 14] who received more than one modality of conventional-dose salvage therapy was analysed. Sixteen patients had a partial response (PR) to 1 degrees ST, but subsequently received 2 degrees ST because the PR was judged to be inadequate (iPR) because of persisting disease bulk or marrow infiltration. Of these 16 patients, 10 (63%) continued to respond to 2 degrees ST. Of the 15 patients who had stable disease following 1 degrees ST, 5 (33%) responded to 2 degrees ST. Only one of the 24 (4%) with progressive disease (PD) following 1 degrees ST, responded to 2 degrees ST. 25 of the 57 patients ultimately underwent stem cell transplantation. The 2-year progression-free survival (PFS) and the 3-year overall survival (OS) for all patients was 24% and 31%, respectively. Long-term survival was highly dependent on response to 1 degrees ST (P = 0.0001); in patients with PD following 1 degrees ST, the PFS and OS at 3 years was only 4%. This analysis indicates that patients with malignant lymphomas, who have PD on 1 degrees ST, are not rescued by subsequent salvage regimens. They should either be treated palliatively or novel approaches should be explored.
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK. kirit.ardeshna@uclh.org
authors.forename: Kirit M
authors.initials: KM
authors.lastname: Ardeshna
authors.forename: Nicholaos
authors.initials: N
authors.lastname: Kakouros
authors.forename: Wendi
authors.initials: W
authors.lastname: Qian
authors.forename: Michael G
authors.initials: MG
authors.lastname: Powell
authors.forename: Nishaat
authors.initials: N
authors.lastname: Saini
authors.forename: Shirley
authors.initials: S
authors.lastname: D'Sa
authors.forename: Stephen
authors.initials: S
authors.lastname: Mackinnon
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: David C
authors.initials: DC
authors.lastname: Linch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D014182:Transplantation, Autologous; D017211:Treatment Failure