A prospective study of intensive induction therapy with high-dose consolidation in patients with aggressive non-Hodgkin's lymphoma and two or three adverse prognostic factors
| Autor: | Fadhela Bouafia, Catherine Thieblemont, Charles Dumontet, Olivier Hequet, Daniel Espinouse, Bertrand Coiffier, Gilles Salles |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Adolescent medicine.medical_treatment Aggressive lymphoma Disease-Free Survival International Prognostic Index Internal medicine Antineoplastic Combined Chemotherapy Protocols Humans Medicine Prospective Studies Prospective cohort study Melphalan Etoposide Chemotherapy Leukopenia Dose-Response Relationship Drug business.industry Lymphoma Non-Hodgkin Cytarabine Induction chemotherapy Hematology Middle Aged Prognosis medicine.disease Carmustine Combined Modality Therapy Surgery Non-Hodgkin's lymphoma Regimen Treatment Outcome Oncology Disease Progression Feasibility Studies Female medicine.symptom business |
| Zdroj: | Leukemia. 14:2159-2165 |
| ISSN: | 1476-5551 0887-6924 |
| DOI: | 10.1038/sj.leu.2401955 |
| Popis: | Patients with nhl and two or three factors of the international prognostic index (ipi) have a poor prognosis. we performed a prospective trial of intensive induction therapy followed with high-dose consolidation in such patients to determine the feasibility of this approach, as well as the response rate and survival. untreated patients with aggressive lymphoma under the age of 60 with two or three adverse prognostic factors (disseminated stage, increased serum ldh, ecog performance status >1) were prospectively included between June 1995 and April 1998 in a trial evaluating intensive induction chemotherapy with the ACE regimen (adriamycin day 1; cyclophosphamide days 1–2; etoposide days 1–3), with G-CSF support. Patients in complete remission after induction received one course of intensification with stem cell support (BEAM regimen), whereas patients in partial response received two intensifications (BEAM, then ICE regimens). Thirty-three patients (median age 38 years) were included. All patients presented WHO grade 4 leukopenia and 84% grade 3–4 thrombocytopenia during induction. There was one toxic death during induction. Twenty-nine patients proceeded to high-dose consolidation, including 12 patients who received a second high-dose treatment. The overall response rate was 88% (95% CI 76–99%), both after induction therapy and treatment completion. Thirty-nine percent of the patients had achieved complete remission after induction, and 73% after treatment completion. With a median follow-up after treatment onset of 29 months, the projected 3-year overall survival was 71% (95% CI 64–78%) and the event-free survival 58% (95% CI 50–66%). Event-free survival was significantly shorter in patients who did not achieve CR after induction therapy or after treatment completion. Early therapeutic intensification after intensive induction chemotherapy is feasible in patients with poor prognosis aggressive NHL and shows promising response and survival rates. |
| Databáze: | OpenAIRE |
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