Authors: Arranz, Reyes¹; Conde, Eulogio²; Grande, Carlos³; Mateos, Maria Victoria⁴; Gandarillas, Marco²; Albo, Carmen⁵; Lahuerta, Juan J.²; Fernández-Rañada, José M.¹; Hernández, Miguel T.⁶; Alonso, Natalia⁷; García Vela, José A.⁸; Garzón, Sebastián⁹; Rodríguez, José¹⁰; Caballero, Dolores⁴

Source: European Journal of Haematology, Volume 80, Number 3, March 2008 , pp. 227-235(9)

Publisher: Wiley-Blackwell

Abstract:

Objectives: 

The role of high-dose therapy and autologous stem-cell transplantation (HDT/ASCT) in the up-front treatment of poor-risk aggressive lymphoma is still unknown. We conducted a prospective multi-centre trial with dose-escalated CHOP (MegaCHOP) and tailored intensification prior to HDT/ASCT according to early response assessed by CT and gallium scan (Ga⁶⁷S). Patients and methods: 

Eighty-six patients with newly diagnosed and Ga-67 avid aggressive B-cell lymphoma received MegaCHOP for three courses and were evaluated for response by CT and Ga⁶⁷S. Patients with CT response and negative Ga⁶⁷S received another MegaCHOP cycle followed by BEAM and ASCT. Those patients with positive Ga⁶⁷S or without CT response received salvage treatment with two courses of ifosfamide and etoposide (IFE) followed, whenever response had been achieved, by BEAM and ASCT. Results: 

Response rate before HDT/ASCT was 85% and, with 34 months of median follow-up, progression-free survival (PFS), overall survival (OS) and treatment-related mortality were 56%, 64% and 7%, respectively. For transplanted patients (81% of the whole series), PFS and OS were 67% and 74%, respectively. No different outcomes were observed between patients achieving an early negative Ga⁶⁷S response treated with MegaCHOP and BEAM/ASCT and patients with mid-treatment positive Ga⁶⁷S who received IFE prior BEAM/ASCT. Conclusions: 

This response-adapted strategy including early treatment modifications prior HDT/ASCT have yielded encouraging PFS and OS in patients with poor-risk B aggressive non-Hodgkin's lymphoma.

Keywords: poor-risk B aggressive non-Hodgkin's lymphoma; early response-adapted treatment; high-dose therapy with autologous stem-cell support; prospective

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-0609.2007.01020.x

Affiliations: 1: Hospital Universitario de La Princesa, Madrid 2: Hospital Marqués de Valdecilla, Santander 3: Hospital 12 de Octubre, Madrid 4: Hospital Clínico de Salamanca, Salamanca 5: Hospital Xeral-Cíes, Vigo 6: Hospital Universitario de Canarias, Tenerife 7: Complejo Hospitalario de Santiago, La Coruña 8: Hospital Universitario de Getafe, Madrid 9: Hospital de Jerez de la Frontera, Cádiz 10: Hospital Universitario Son Dureta, Palma de Mallorca, Spain

Publication date: 2008-03-01

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• By this author: Arranz, Reyes ;  Conde, Eulogio ;  Grande, Carlos ;  Mateos, Maria Victoria ;  Gandarillas, Marco ;  Albo, Carmen ;  Lahuerta, Juan J. ;  Fernández-Rañada, José M. ;  Hernández, Miguel T. ;  Alonso, Natalia ;  García Vela, José A. ;  Garzón, Sebastián ;  Rodríguez, José ;  Caballero, Dolores

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