High-dose therapy and autologous stem-cell transplantation versus conventional therapy for patients with advanced Hodgkin's lymphoma responding to front-line therapy

Massimo Federico, Monica Bellei, Pauline Brice, Maura Brugiatelli, Arnon Nagler, Christian Gisselbrecht, Luciano Moretti, Philippe Colombat, Stefano Luminari, Francesco Fabbiano, Nicola Di Renzo, Anthony Goldstone, Angelo Michele Carella

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To determine whether high-dose therapy (HDT) with autologous stem-cell transplantation (ASCT) should be included in the initial consolidative treatment of patients with advanced, unfavorable Hodgkin's lymphoma (HL). Patients and Methods: One hundred sixty-three patients achieving complete remission (CR) or partial remission (PR) with four initial courses of doxorubicin, bleomycin, vinblastine, and dacarbazine, or other doxorubicin-containing regimens, were randomly assigned to receive HDT plus ASCT (83 patients) versus four courses of conventional chemotherapy (80 patients). Unfavorable HL was defined as the presence of at least two of the following poor prognostic factors: high lactate dehydrogenase level, large mediastinal mass (greater than at least 33% of the thoracic diameter), more than one extranodal site, low hematocrit level, and inguinal involvement. Results: At the end of the treatment program, 92% of patients in arm A and 89% in arm B achieved a CR (P = .6). After a median follow-up of 48 months, the 5-year failure-free survival rates were 75% (95% confidence interval [CI], 65 to 85) in arm A and 82% (95% CI, 73 to 90) in arm B (P = .4). The 5-year overall survival rates were 88% (95% CI, 80 to 96) in arm A and 88% (95% CI, 79 to 96) in arm B (P = .99). The 5-year relapse-free survival rates were 88% in arm A (95% CI, 80 to 96) and 94% in arm B (95% CI, 88 to 100), and the difference was not significant (P = .3). Conclusion: Patients with advanced unfavorable HL achieving CR or PR after four courses of doxorubicin-containing regimens have a favorable outcome with conventional chemotherapy. No benefit from an early intensification with HDT and ASCT was shown.

Original languageEnglish
Pages (from-to)2320-2325
Number of pages6
JournalJournal of Clinical Oncology
Volume21
Issue number12
DOIs
Publication statusPublished - Jun 15 2003

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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