© 2004 European Society for Medical Oncology
Original Article |
Long-term follow-up after high-dose chemotherapy and autologous stem-cell transplantation for high-grade B-cell lymphoma suggests an improved outcome for high-risk patients with respect to the age-adjusted International Prognostic Index
Albert Ludwigs University Medical Center, Department of Hematology and Oncology, Freiburg, Germany
* Correspondence to: Dr J. Finke, Albert Ludwigs University Medical Center, Department of Hematology and Oncology, Hugstetter Str. 55, D-79106 Freiburg, Germany. Tel: +49-761-270-3408; Fax: +49-761-270-3658; Email: finke{at}mm11.ukl.uni-freiburg.de
Background: To evaluate the long-term benefit from high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT), as part of the initial treatment for patients with chemosensitive, high-grade B non-Hodgkin's lymphoma (hg B-NHL), stratified according to the age-adjusted International Prognostic Index (aaIPI).
Patients and methods: Eligible patients were 33 consecutive hg B-NHL patients responding to first-line chemotherapy and fulfilling at least one of the following criteria: stage III or IV, bulky disease, elevated lactate dehydrogenase or failure to achieve complete remission (CR). Twenty-two of 33 patients (67%) had two or three risk factors with respect to the aaIPI. All patients received HDCT with ASCT after a minimum of 6 weeks of VACOP-B standard therapy and VIP-E for mobilization.
Results: After ASCT, 31 patients (94%) achieved CR. No treatment-related death occurred. The cumulative incidence of relapse at a medium follow-up of 10 years is 16% for 31 of 33 patients achieving CR. Twenty-five of 33 patients are in sustained CR with a disease-free survival of 76% [95% confidence interval (CI) 67% to 86%]. The overall survival at a median follow-up of 122 months (range 86–148) is 79% (95% CI 68% to 89%).
Conclusions: The results suggest that up-front HDCT with ASCT may improve long-term outcome in high-risk patients with chemotherapy-sensitive hg B-NHL when compared to historic populations treated solely with dose-intense chemotherapy. We observed that long-term survival of high-risk (two to three risk factors) patients is comparable to low-risk (zero to one risk factor) patients after HDCT and ASCT with a low incidence of late relapse.
Key words: age-adjusted international prognostic index (aaIPI), autologous stem-cell transplantation (ASCT), chemosensitive disease, high-grade B-cell non-Hodgkin's lymphoma (hg B-NHL), high-dose chemotherapy (HDCT), long-term follow-up
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