Autologous Transplantation as Consolidation for Aggressive Non-Hodgkin's Lymphoma

Abstract

Background The efficacy of autologous stem-cell transplantation during the first remission in patients with diffuse, aggressive non-Hodgkin's lymphoma classified as high-intermediate risk or high risk on the International Prognostic Index remains controversial and is untested in the rituximab era. Methods We treated 397 patients who had disease with an age-adjusted classification of high risk or high-intermediate risk with five cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP plus rituximab. Patients with a response were randomly assigned to receive three additional cycles of induction chemotherapy (control group) or one additional cycle of induction chemotherapy followed by autologous stem-cell transplantation (transplantation group). The primary efficacy end points were 2-year progression-free survival and overall survival. Results Of 370 induction-eligible patients, 253 were randomly assigned to the transplantation group (125) or the control group (128). Forty-six patients in the transplantation group and 68 in the control group had disease progression or died, with 2-year progression-free survival rates of 69 and 55%, respectively (hazard ratio in the control group vs. the transplantation group, 1.72; 95% confidence interval [CI], 1.18 to 2.51; P = 0.005). Thirty-seven patients in the transplantation group and 47 in the control group died, with 2-year overall survival rates of 74 and 71%, respectively (hazard ratio, 1.26; 95% CI, 0.82 to 1.94; P = 0.30). Exploratory analyses showed a differential treatment effect according to risk level for both progression-free survival (P = 0.04 for interaction) and overall survival (P = 0.01 for interaction). Among high-risk patients, the 2-year overall survival rate was 82% in the transplantation group and 64% in the control group. Conclusions Early autologous stem-cell transplantation improved progression-free survival among patients with high-intermediate-risk or high-risk disease who had a response to induction therapy. Overall survival after transplantation was not improved, probably because of the effectiveness of salvage transplantation.

Redefining the role of etoposide in first-line treatment of peripheral T-cell lymphoma

“…As reported by previous studies, ASCT in the salvage setting is as useful in PTCL as it is in aggressive B-cell lymphomas 25 and is also beneficial as consolidation after first remission in aggressive non-Hodgkin lymphoma. 26 On the basis of these findings and our subgroup analysis, we suggest that HSCT has at least some positive roles in treatment of PTCL, especially as consolidation during first remission. Instead of intensification of induction chemotherapy, selective administration of consolidative transplantation can be a judicious treatment strategy for PTCL.…”

Efficacy of rituximab maintenance therapy for aggressive B-cell lymphoma depends on use of rituximab in induction therapy: a meta-analysis of randomized controlled trials

“…Considering that, in the rituximab era, the role of consolidative autologous stem-cell transplantation proved to be ambiguous even for high-risk aggressive lymphoma, 9 we should make an attempt to explore other modalities. Alternatively, identifying the beneficial features for patients from these consolidative treatments would be a realistic approach.…”

Treatment of Diffuse Large B-Cell Lymphoma

“…SWOG conducted a phase III randomized trial (S9704) in DLBCL patients 15-65 years of age with an aa-IPI score of 2-3 by comparing 5 cycles of CHOP±R followed by 1 cycle of CHOP±R and ASCT with 3 cycles of CHOP±R. 16 The ASCT group showed a significantly better 2-year PFS than did the CHOP±R group (69% vs. 55%, p = 0.005). In contrast, there was no significant difference in the 2-year OS (74%, 71%, p = 0.30).…”