Premium
Dose‐escalated CHOP and tailored intensification with IFE according to early response and followed by BEAM/autologous stem‐cell transplantation in poor‐risk aggressive B‐cell lymphoma: a prospective study from the GEL–TAMO Study Group
Author(s) -
Arranz Reyes,
Conde Eulogio,
Grande Carlos,
Mateos Maria Victoria,
Gandarillas Marco,
Albo Carmen,
Lahuerta Juan J.,
FernándezRañada José M.,
Hernández Miguel T.,
Alonso Natalia,
García Vela José A.,
Garzón Sebastián,
Rodríguez José,
Caballero Dolores
Publication year - 2008
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2007.01020.x
Subject(s) - autologous stem cell transplantation , medicine , etoposide , aggressive lymphoma , oncology , prospective cohort study , transplantation , progression free survival , lymphoma , surgery , chemotherapy , rituximab
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 (Ga 67 S). 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 Ga 67 S. Patients with CT response and negative Ga 67 S received another MegaCHOP cycle followed by BEAM and ASCT. Those patients with positive Ga 67 S 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 Ga 67 S response treated with MegaCHOP and BEAM/ASCT and patients with mid‐treatment positive Ga 67 S 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.