title: Salvage chemotherapy and autologous stem cell transplantation for transformed indolent lymphoma: a subset analysis of NCIC CTG LY12.
abstract: The treatment of transformed indolent lymphoma (TRIL) often includes salvage chemotherapy (SC) and autologous stem cell transplant (ASCT). NCIC CTG LY12 is a randomized phase 3 trial comparing gemcitabine, dexamethasone, and cisplatin (GDP) with dexamethasone, cytarabine, and cisplatin (DHAP) before ASCT. This analysis compares the results of SC and ASCT for TRIL with de novo diffuse large B-cell lymphoma (DLBCL). Six-hundred nineteen patients with relapsed/refractory aggressive non-Hodgkin lymphoma were randomized to GDP or DHAP; 87 patients (14%) had TRIL and 429 (69%) had DLBCL. The response rate to SC was 47% in TRIL and 45% in DL (P = .81). Transplantation rates were similar: TRIL 53% and DL 52% (P = 1.0). With a median follow-up of 53 months, 4 year overall survival was 39% for TRIL and 41% for DL (P = .78); 4 year event-free survival (EFS) was 27% for TRIL and 27% for DL (P = .83). Post-ASCT, 4-year EFS was 45% for TRIL and 46% for DL. Histology (TRIL or DL) was not a predictor of any outcome in multivariate models. Patients with relapsed or refractory TRIL and DLBCL have similar outcomes with SC and ASCT; this therapy should be considered the standard of care for patients with TRIL who have received prior systemic chemotherapy. NCIC CTG LY12 is registered at ClinicalTrials.gov as #NCT00078949.
authors.affiliation: Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada;
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-6117-320X
authors.initials: J
authors.lastname: Kuruvilla
authors.affiliation: Hematology, Queen Elizabeth II Health Sciences Centre, Halifax, Canada;
authors.forename: David A
authors.initials: DA
authors.lastname: MacDonald
authors.affiliation: Hematology, Juravinski Cancer Centre, Hamilton, Canada;
authors.forename: C Tom
authors.initials: CT
authors.lastname: Kouroukis
authors.affiliation: Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada;
authors.forename: Matthew
authors.initials: M
authors.lastname: Cheung
authors.affiliation: Hematologic Oncology, Centre hospitalier de l'université de Montréal-Hôpital Notre-Dame, Montreal, Canada;
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Olney
authors.affiliation: Department of Oncology, Cross Cancer Institute, Edmonton, Canada;
authors.forename: A Robert
authors.initials: AR
authors.lastname: Turner
authors.affiliation: Medical Oncology, Stronach Regional Cancer Centre, Newmarket, Canada;
authors.forename: Peter
authors.initials: P
authors.lastname: Anglin
authors.affiliation: Hematologic Oncology, Cancer Care Manitoba, Winnipeg, Canada;
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.affiliation: Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada;
authors.forename: Walid Sabry
authors.initials: WS
authors.lastname: Ismail
authors.affiliation: University of Modena and Reggio Emilia, Modena Italy;
authors.forename: Stefano
authors.initials: S
authors.lastname: Luminari
authors.affiliation: Hematology, Queen Elizabeth II Health Sciences Centre, Halifax, Canada;
authors.forename: Stephen
authors.initials: S
authors.lastname: Couban
authors.affiliation: Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Canada;
authors.forename: Tara
authors.initials: T
authors.lastname: Baetz
authors.affiliation: National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Canada; and.
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Meyer
authors.affiliation: National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Canada; and.
authors.forename: Annette E
authors.initials: AE
authors.lastname: Hay
authors.affiliation: National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Canada; and.
authors.forename: Lois
authors.initials: L
authors.lastname: Shepherd
authors.affiliation: National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Canada; and.
authors.forename: Marina S
authors.initials: MS
authors.lastname: Djurfeldt
authors.affiliation: Division of Hematology, Queen's University, Kingston Canada.
authors.forename: Sameer
authors.initials: S
authors.lastname: Alamoudi
authors.affiliation: National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Canada; and.
authors.forename: Bingshu E
authors.initials: BE
authors.lastname: Chen
authors.affiliation: Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada;
authors.forename: Michael
authors.initials: M
authors.lastname: Crump
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D000093542:Gemcitabine
chemical_list: D003561:Cytarabine; D003841:Deoxycytidine; D005047:Etoposide; D003907:Dexamethasone; D002945:Cisplatin; D000093542:Gemcitabine