autologous blood and marrow transplantation - Blog Science ...

Santini et al. 193
to evaluate the effectiveness of aggressive therapy in improving outcome. One
hundred twenty-four patients between the ages of 15 and 60 years were included
in the trial. Diagnosis had confirmed diffuse intermediate- to high-grade non-
Hodgkin's lymphoma (Working Formulation groups F, G, H, and K) in stages II
bulky (>10 cm), III, or IV. All patients were randomized at diagnosis. Sixty-one
patients were assessed to receive etoposide, doxorubicin, cyclophosphamide,
vincristine, prednisone, bleomycin (VACOP-B) for 12 weeks and dexamethasone,
cytarabin, cisplatin (DHAP) as salvage regimen (arm A), while 63
patients were to receive VACOP-B for 12 weeks plus high-dose therapy (HDT)
and autologous bone marrow transplantation (arm B). There was no significant
difference in the frequency of complete remission (CR) between the two groups:
75% for the VACOP-B plus DHAP regimen group and 73% for the VACOP-B
plus autoBMT group. With a median follow-up observation time of 37 months
(range 10-72 months), the 6-year survival probability was 64% in arm A and
65% in arm B. There was no difference in the 6-year disease-free survival (DFS)
and progression-free survival (PFS) probability of the two groups. DFS was 57%
with conventional chemotherapy and 80% with autoBMT (P=0.1). PFS was 47
and 60%, respectively (P=0A). Results of patients categorized according to the
International Index as being at risk were analyzed. This showed a statistical
improvement in terms of DFS (P=0.0l) and a favorable trend in terms of PFS
(/>=0.08) for intermediate-/high- plus high-risk group patients receiving
autoBMT compared with patients categorized in the same groups who were
treated with conventional chemotherapy. In this study, conventional
chemotherapy followed by HDT and autoBMT as front-line therapy seems to be
no more successful than conventional treatment in terms of overall results.
However, our study suggests that HDT plus ABMT should be proposed for
higher-risk group patients at diagnosis.
INTRODUCTION
HDT with ABMT represents an efficient approach (30-40% cure rate) for those
aggressive non-Hodgkin's lymphoma (NHL) patients who have "chemosensitive
relapse" after the failure of conventional chemotherapy. 1
" 4
Its true role in the
treatment of patients in first partial remission (PR) after front-line therapy is still
uncertain. 5,6
Haioun et al., in a randomized trial, demonstrated no difference in
terms of overall survival and DFS between patients in CR receiving conventional
therapy or HDT plus autoBMT. 7
This contrasts with previous reports of nonrandomized
trials. 8,9
In a retrospective analysis, the same authors suggested a survival
benefit for intermediate-/high- and high-risk patients (as defined by the
International Index 10
) treated with HDT and autoBMT. 11
A different approach
using sequential chemotherapeutic agents given at full dosage (high-dose