Upfront high-dose sequential therapy (HDS) versus VACOP-B with or without HDS in aggressive non-Hodgkin's lymphoma: Long-term results by the NHLCSG

A. Olivieri, G. Santini, C. Patti, T. Chisesi, C. De Souza, A. Rubagotti, S. Aversa, A. Billio, A. Porcellini, M. Candela, R. Centurioni, A. M. Congiu, M. Brunori, S. Nati, M. Spriano, R. Vimercati, G. Marino, A. Contu, L. Tedeschi, I. MajolinoM. Crugnola, M. R. Sertoli

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is not univocal concordance for using high-dose sequential therapy (HDS) as first-line treatment for aggressive non-Hodgkin's lymphoma (NHL). We designed this study to evaluate the usefulness of HDS followed by high-dose therapy (HDT) with autologous stem cell transplantation as front-line treatment in different subsets of aggressive NHL. Patients and methods: Among 223 patients aged 15-60 years with aggressive, advanced stage NHL, 106 patients were randomized to VACOP-B (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin) for 12 weeks (plus HDS/HDT in case of persistent disease) (arm A), and 117 patients to VACOP-B for 8 weeks plus upfront HDS/HDT (arm B). Results: According to the intention-to-treat analysis, the complete response rate was 75% for arm A and 72.6% for arm B. With a median follow-up of 62 months there was no difference in 7-year probability of survival (60% and 57.8%; P- 0.5), disease-free survival (DFS) (62% and 71%; P = 0.2) and progression-free survival (PFS) (44.9% and 40.9%; P = 0.7) between the two arms. Subgroup analyses confirmed that the best results in terms of survival, DFS and PFS were achieved by patients with large B-cell NHL without bone marrow (BM) involvement, independently of the treatment arm. Results were poorer in other categories of patients and poorest in patients with BM involvement. Conclusions: Aggressive NHL patients do not benefit from upfront HDS/HDT.

Original languageEnglish
Pages (from-to)1941-1948
Number of pages8
JournalAnnals of Oncology
Volume16
Issue number12
DOIs
Publication statusPublished - Dec 2005

Keywords

  • Autologous stem cell transplantation
  • High-dose sequential therapy
  • High-grade NHL
  • VACOP-B

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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