Initial chemotherapy with mitoxantrone, chlorambucil, prednisone impairs the collection of stem cells in patients with indolent lymphomas--results of a randomized comparison by the German Low-Grade Lymphoma Study Group.
Myeloablative radio-chemotherapy with subsequent autologous stem cell transplantation (ASCT) significantly prolongs progression free and probably overall survival in follicular lymphoma (FL) in first remission. The current trial explored prospectively the rate of successful stem cell mobilization in patients with advanced stage FL after initial therapy with either Mitoxantrone, Chlorambucil, Prednisone (MCP) or Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (CHOP) as part of a prospective randomized comparison of both regimens. ASCT patients received Dexa-BEAM (Dexamethasone, BCNU, Melphalan, Etoposide, Cytarabine) for mobilization of stem cells. Stem cells were collected and a minimum of 2x2.0x106/kg bw CD34+ was required for ASCT. Of 79 evaluable patients, 58 (73%) had follicular lymphoma, 13 (16%) mantle cell lymphoma and 8 (10%) lymphoplasmacytic lymphoma. In the 45 patients assigned to CHOP, stem cell collection was successful in 42 cases (93%, 95% CI 82% to 99%). This high mobilization rate after CHOP could be confirmed in 61 subsequent patients (87%). In contrast, after MCP therapy stem cell collection was successful in only 15 of 34 patients (44%, 95% CI 27% to 62%; P=0.0003). In conclusion, initial therapy with MCP significantly impairs the ability to collect stem cells and should be avoided for first line therapy of younger patients potentially qualifying for high dose consolidation and ASCT in first remission.
Nickenig
C
C
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern.
Dreyling
M
M
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern.
Hoster
E
E
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern; Institute of Medical Informatics, Biometry and Epidemiology, University of Munich.
Ludwig
W-D
WD
Department of Hematology and Oncology, Charité Campus Berlin-Buch.
Dörken
B
B
Department of Hematology and Oncology, Charité Berlin Campus Virchow-Klinikum.
Freund
M
M
Division of Hematology and Oncology, University Rostock.
Huber
C
C
Department of Internal Medicine III, University of Mainz.
Ganser
A
A
Department of Hematology, Hemostasis and Oncology, Hannover Medical School.
Trümper
L
L
Department of Hematology and Oncology, Georg-August University, Göttingen, Germany.
Forstpointner
R
R
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern.
Unterhalt
M
M
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern.
Hiddemann
W
W
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern. Electronic address: Wolfgang.Hiddemann@med.uni-muenchen.de.
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002330:Carmustine / Q000627:therapeutic use; D002699:Chlorambucil / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005858:Germany / Q000453:epidemiology; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D008942:Mitoxantrone / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D003561:Cytarabine; D002699:Chlorambucil; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone