High-Dose Chemotherapy with Autologous Stem Cell Support Is Not Superior to Conventional-Dose Chemotherapy in the First-Line Treatment of Aggressive Non-Hodgkin Lymphoma - Results of a Comprehensive Meta-Analysis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 920-920 ◽  
Author(s):  
Alexander Greb ◽  
Daniel H. Schiefer ◽  
Julia Bohlius ◽  
Guido Schwarzer ◽  
Andreas Engert
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Line Treatment ◽  
First Line ◽  
Conventional Chemotherapy ◽  
Non Hodgkin Lymphoma ◽  
Cell Support ◽  
First Line Treatment

Abstract Background: High-dose chemotherapy with autologous stem cell support (HDT) has been proven effective in relapsed aggressive Non-Hodgkin lymphoma (NHL). However, conflicting results of HDT as part of first-line treatment have been reported in randomized controlled trials (RCTs). Here, we report our updated meta-analysis to better define the role of HDT in these patients. Methods: RCTs were identified by computerized search and handsearching of conference proceedings. Data extraction and quality assessment was performed independently by two reviewers. First authors were contacted to request individual patient data. Eight investigators provided us with individual patient data, for five trials data were extracted from survival curves. The hazard ratio (HR) was used as a measure of treatment effect; the inverse variance method (fixed effect model) was used for pooling. The relative risk was determined for binary data. Results: 15 RCTs including 3079 patients were eligible for this meta-analysis. Overall treatment-related mortality was 6.0% in the HDT group and not significantly different compared to conventional chemotherapy (RR 1.33, p=0.59). Analysis of 13 studies including 2018 patients showed significantly higher CR rates in the group receiving HDT (RR 1.10, p=0.004). However, HDT did not have an effect on OS, when compared to conventional chemotherapy. The pooled HR was 1.04 (p=0.58). There was no statistical heterogeneity among the trials and sensitivity analyses underscored the robustness of these results. Subgroup analysis of prognostic groups according to IPI did not show any survival difference between HDT and controls in 12 trials (low and low-intermediate risk IPI: HR 1.41, high-intermediate and high risk IPI: HR 0.97). Event-free survival (EFS) also showed no significant difference between HDT and CT (HR 0.93, p=0.31). We incorporated several additional variables to possibly identify other risk factors such as the proportions of diffuse large cell lymphoma, protocol adherence, the HDT strategy used, response status of patients before HDT, the conditioning regimen used, and methodological issues. However, our analyses demonstrate that the results described here are not related on either of these factors. Conclusion: Despite higher CR rates, there is no benefit for HDT in patients with aggressive NHL when incorporated in first-line treatment.

Feasibility of High-Dose Chemotherapy without Stem Cell Support as a First-Line Treatment for Non-Hodgkin's Aggressive Lymphoma: A Pilot Study

2000 ◽  
Vol 36 (3-4) ◽  
pp. 315-321 ◽  
Author(s):  
Ryuichi Inoue ◽  
Toshiki Natazuka ◽  
Manabu Shimoyama ◽  
Akira Tamekane ◽  
Yoshikazu Kajimoto ◽  
...  
Keyword(s):  
Stem Cell ◽  
Pilot Study ◽  
High Dose Chemotherapy ◽  
Aggressive Lymphoma ◽  
High Dose ◽  
Line Treatment ◽  
First Line ◽  
Stem Cell Support ◽  
Cell Support ◽  
First Line Treatment

scholarly journals Relapsed Nodular Lymphocyte-Predominant Hodgkin Lymphoma: An Analysis from the German Hodgkin Study Group (GHSG)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 922-922 ◽  
Author(s):  
Dennis A. Eichenauer ◽  
Annette Pluetschow ◽  
Lena Schroeder ◽  
Michael Fuchs ◽  
Bastian von Tresckow ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Disease Recurrence ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Line Treatment ◽  
First Line ◽  
Conventional Chemotherapy ◽  
Antibody Treatment ◽  
Anti Cd20 ◽  
First Line Treatment

Abstract Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity accounting for approximately 5% of all Hodgkin lymphoma (HL) cases. Pathological and clinical features differ from classical HL (cHL). Pathologically, the malignant lymphocyte predominant (LP) cells stain consistently positive for CD20 and are negative for CD30. Clinically, NLPHL often has an indolent course. However, patients tend to develop late and multiple relapses. Since data on the treatment of relapsed NLPHL are scarce, we used the database of the German Hodgkin Study Group (GHSG) to obtain information on characteristics, treatment and outcome of NLPHL patients with disease recurrence after initial response to first-line treatment. A total of 99 patients who had their first-line treatment within 12 GHSG studies between 1993 and 2008 and subsequently relapsed with NLPHL histology were identified and considered for the present analysis. Patients with primary disease progression or transformation into aggressive B-cell non-Hodgkin lymphoma (NHL) at relapse were not included. At initial NLPHL diagnosis, the median age of the 99 eligible patients was 40 years; 66% of patients had early favorable, 14% had early unfavorable and 20% had advanced stages. First-line treatment consisted of radiotherapy (RT) alone in 22%, combined-modality treatment (CMT) in 68%, single agent anti-CD20 antibody treatment with rituximab in 7% and chemotherapy alone in 3% of patients. At a median observation of 10.8 years from initial diagnosis, relapse occurred after a median of 6.2 years. At relapse, 32% of patients received RT alone or conventional chemotherapy followed by RT, 28% received high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) and 26% had anti-CD20 antibody treatment either alone or in combination with conventional chemotherapy. In 13% of cases, patients either received no salvage treatment or the kind of salvage treatment was unknown. At a median observation of 3.8 years after disease recurrence, 11% of patients had developed a second relapse and 4% a third relapse. Five-year progression-free survival (PFS) estimates after occurrence of the first relapse were 78.6% (95%-CI: 61.6%-95.6%), 90.0% (95%-CI: 76.5%-100%) and 72.4% (95%-CI: 53.6%-91.2%) after salvage treatment with RT alone or conventional chemotherapy followed by RT, high-dose chemotherapy followed by ASCT and anti-CD20 antibody treatment optionally combined with conventional chemotherapy, respectively. Thus, there were no significant differences between the applied approaches. Only 10 patients (10%) died during observation; 5 deaths were NLPHL-related, 3 patients died due to second malignancies, and 1 patient each died from respiratory failure and infection. Hence, 90% of NLPHL patients who developed disease recurrence after initial response to first-line treatment were alive at the end of follow-up. Given these excellent survival data, it appears necessary to define patients who are sufficiently treated with non-toxic approaches associated with a potentially low risk for the development of late effects. A pragmatic approach based on the present data may consist in the division of relapsed NLPHL patients into 2 groups. Patients with a longer remission after first-line treatment who present with limited tumor mass at relapse may be treated with anti-CD20 antibodies alone or in combination with conventional chemotherapy, RT alone or conventional chemotherapy followed by RT. In contrast, patients with early disease recurrence and more extensive disease at relapse including extranodal involvement may require more aggressive treatment consisting of high-dose chemotherapy followed by ASCT. Disclosures von Tresckow: Novartis: Consultancy, Other: travel grants, Research Funding; Takeda: Consultancy, Other: travel grants; Millenium: Consultancy. Engert:Takeda: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding.

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