Randomized study to evaluate the use of high-dose therapy as part of primary treatment for "aggressive" lymphoma

Research output: Contribution to journalArticle

Abstract

Purpose: This trial of the German High-Grade Non-Hodgkin's Lymphoma Study Group compares the use of high-dose therapy (HDT) as part of primary treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide followed by involved-field (IF) radiotherapy in a randomized, multicenter, phase III study. Patients and Methods: Three hundred twelve patients with "aggressive" non-Hodgkin's lymphoma aged greater than or equal to 60 years with elevated serum lactate dehydrogenase levels were included from 1990 to 1997. Patients with at least a minor response after two cycles of CHOEP (CHOP + etoposide 3 x 100 mg/m(2)) were to receive three further cycles of CHOEP followed by IF radiotherapy (arm A) or one further cycle of CHOEP followed by autologous stem-cell transplantation and IF radiotherapy (arm B). Results: Among 158 patients randomized to arm B, 103 (65%) received HDT. The complete remission rate at the end of treatment was 62.9% in arm A and 69.9% in arm B. With a median observation time of 45.5 months, overall survival for all 312 patients was 63% after 3 years (63% for arm A, 62% for arm B; P = .68). Event-free survival was 49% for arm A versus 59% for arm B (P = .22). Relapse in arm B was associated with a significantly worse survival rate than relapse in arm A (P < .05). Relapse after HDT occurred early (median interval, 3 months). Six patients developed secondary neoplasia, three in arm A and three in arm B. Conclusion: Results of the randomized trial comparing CHOP-like chemotherapy with early HDT do not support the use of HDT with carmustine, etoposide, cytarabine, and melphalan following shortened standard chemotherapy.

Details

Authors
  • U Kaiser
  • L Uebelacker
  • U Abel
  • J Birkmann
  • L Trumper
  • H Schmalenberg
  • T Karakas
  • B Metzner
  • DK Hossfeld
  • HG Bischoff
  • A Franke
  • M Reiser
  • P Muller
  • L Mantovani
  • M Grundeis
  • F Rothmann
  • CU von Seydewitz
  • RM Mesters
  • EU Steinhauer
  • D Krahl
  • And 9 others
  • K Schumacher
  • M Kneba
  • M Baudis
  • N Schmitz
  • R Pfab
  • H Koppler
  • R Parwaresch
  • M Pfreundschuh
  • K Havemann
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)4413-4419
JournalJournal of Clinical Oncology
Volume20
Issue number22
Publication statusPublished - 2002
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes