Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d'Etude des Lymphomes de l'Adulte (GELA).
The purpose of this study is to compare our standard chemotherapy regimen (CHVP [cyclophosphamide, doxorubicin, teniposide, and prednisone]) plus interferon with 4 courses of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by high-dose therapy with autologous stem cell transplantation (ASCT) in treatment-naive patients with advanced follicular lymphoma. Four hundred one patients were included from July 1994 to March 2001: 209 received 12 cycles of CHVP plus interferon alpha for 18 months (CHVP-I arm) and 192 received 4 cycles of CHOP followed by high-dose therapy (HDT) with total body irradiation and ASCT (CHOP-HDT arm). Overall response rates were similar in both groups (79% and 78% after induction chemotherapy, respectively). One hundred thirty-one of the 150 patients eligible for HDT underwent transplantation (87%). Intent-to-treat analysis after a median follow-up of 7.5 years showed that there was no difference between the 2 arms for overall survival (P = .53) or event-free survival (P = .11). Patients with a complete response at the end of the induction therapy had a statistically longer event-free survival and overall survival (P = .02 and < .001, respectively). After long-term follow-up, our study showed that there was no statistically significant benefit in favor of first-line high-dose therapy in patients with follicular lymphoma. High-dose therapy should be reserved for relapsing patients.
Sebban
Catherine
C
Centre Léon Bérard, 28 Rue Laennec, 69008 Lyon, France. sebban@lyon.fnclcc.fr
Mounier
Nicolas
N
Brousse
Nicole
N
Belanger
Coralie
C
Brice
Pauline
P
Haioun
Corinne
C
Tilly
Herve
H
Feugier
Pierre
P
Bouabdallah
Redah
R
Doyen
Chantal
C
Salles
Gilles
G
Coiffier
Bertrand
B
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001530:Belgium; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005602:France; D006801:Humans; D007370:Interferon Type I / Q000627:therapeutic use*; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D011994:Recombinant Proteins; D013713:Teniposide / Q000627:therapeutic use; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D007370:Interferon Type I; D011994:Recombinant Proteins; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D013713:Teniposide; D011241:Prednisone