Sequential high dose chemotherapy as initial treatment for aggressive sub-types of Non-Hodgkin Lymphoma: Results of the international randomized phase III trial (MISTRAL)

D. C. Betticher, G. Martinelli, J. A. Radford, M. Kaufmann, M. J S Dyer, U. Kaiser, W. E. Aulitzky, J. Beck, A. von Rohr, T. Kovascovics, S. B. Cogliatti, S. Cina, R. Maibach, T. Cerny, D. C. Linch

Research output: Contribution to journalArticle

Abstract

Introduction: Sequential high dose (SHiDo) chemotherapy with stem cell support has been shown to prolong the event-free survival in patients with diffuse large B-cell lymphoma. Methods: To confirm this result in a multicenter trial, we randomized patients with aggressive NHL, to receive either eight cycles of CHOP or SHiDo. The primary endpoint was overall survival. Results: 129 evaluable patients were randomized to receive either CHOP or SHiDo: median age, 48 years; 62% male; stage III+IV: 73%; age adjusted International Prognostic Index 1/2/3: 21%/52%/27%. Toxicity grades 3+4 were more pronounced in the SHiDo-arm with 13% versus 3% of patients with fever; 34% versus 13% with infections; 13% versus 2% with esophagitis/dysphagia/gastric ulcer. The remission rates were similar in SHiDo and CHOP arms with 34%/37% complete remissions and 31%/31% partial remissions, respectively. After a median observation time of 48 months, there was no difference in overall survival at 3 years, with 46% for SHiDo and 53% for CHOP (P = 0.48). Conclusion: In this multicenter trial, early intensification with SHiDo did not confer any survival benefit in previously untreated patients with aggressive NHL and was associated with a higher incidence of grades 3/4 toxicity.

Original languageEnglish
Pages (from-to)1546-1552
Number of pages7
JournalAnnals of Oncology
Volume17
Issue number10
DOIs
Publication statusPublished - Oct 2006

Keywords

  • Aggressive lymphoma
  • Autologus bone marrow transplantation
  • Diffuse large cell lymphoma
  • Sequential high dose chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Betticher, D. C., Martinelli, G., Radford, J. A., Kaufmann, M., Dyer, M. J. S., Kaiser, U., Aulitzky, W. E., Beck, J., von Rohr, A., Kovascovics, T., Cogliatti, S. B., Cina, S., Maibach, R., Cerny, T., & Linch, D. C. (2006). Sequential high dose chemotherapy as initial treatment for aggressive sub-types of Non-Hodgkin Lymphoma: Results of the international randomized phase III trial (MISTRAL). Annals of Oncology, 17(10), 1546-1552. https://doi.org/10.1093/annonc/mdl153