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Conventional second‐line salvage chemotherapy regimens are not warranted in patients with malignant lymphomas who have progressive disease after first‐line salvage therapy regimens
Author(s) -
Ardeshna Kirit M.,
Kakouros Nicholaos,
Qian Wendi,
Powell Michael G.,
Saini Nishaat,
D'Sa Shirley,
Mackin Stephen,
Hoskin Peter J.,
Goldstone Anthony H.,
Linch David C.
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05603.x
Subject(s) - salvage therapy , medicine , regimen , progressive disease , lymphoma , chemotherapy , refractory (planetary science) , transplantation , surgery , oncology , physics , astrobiology
Summary 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°ST) and who subsequently receive a second‐line salvage regimen (2°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°ST, but subsequently received 2°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°ST. Of the 15 patients who had stable disease following 1°ST, 5 (33%) responded to 2°ST. Only one of the 24 (4%) with progressive disease (PD) following 1°ST, responded to 2°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°ST ( P = 0·0001); in patients with PD following 1°ST, the PFS and OS at 3 years was only 4%. This analysis indicates that patients with malignant lymphomas, who have PD on 1°ST, are not rescued by subsequent salvage regimens. They should either be treated palliatively or novel approaches should be explored.