Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma:: Final analysis of the prospective LNH87-2 protocol -: A Groupe d'Etude des Lymphomes de l'Adulte Study
Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma:: Final analysis of the prospective LNH87-2 protocol -: A Groupe d'Etude des Lymphomes de l'Adulte Study
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DOI：
10.1200/jco.2000.18.16.3025
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发表时间：
2000-08-01
影响因子：
45.3
通讯作者：
Reyes, F
中科院分区：
文献类型：
--
作者：
Haioun, C;Lepage, E;Reyes, F
目的:通过中位随访8年的LNH87-2随机研究的最终分析，该研究比较了侵袭性非霍奇金淋巴瘤患者诱导后首次完全缓解的巩固序贯化疗（异环磷酰胺加依托泊苷、天冬酰胺酶和阿糖胞苷）与使用环磷酰胺、卡莫司汀和依托泊苷（CBV方案）的高剂量治疗（HDT）和干细胞移植。重点关注年龄调整国际预后指数确定的高/中高风险患者。患者和方法：在916例符合条件的患者中，451例存在2个（n = 318）或3个（n = 133）危险因素。在诱导治疗达到完全缓解后，236例高风险患者可在巩固期进行评估，其中125例患者在HDT组，111例患者在序贯化疗组。结果：在451例高危患者中，277例（61%）在诱导治疗后达到完全缓解。在236例随机患者中，HDT优于序贯化疗，1年无病生存率分别为55%（95%可信区间[CI]， 46%至64%）和39% (95% CI， 30%至48%)（P = 0.02；相对危险度为1.56）。HDT组的8年生存率（64%,95% CI, 55% ~ 73%）明显优于序贯化疗组（49%,95% CI, 39% ~ 59%） （P = 0.04：相对危险度，1.51）。根据对这一系列前瞻性治疗患者的最终分析，并根据国际预后指数（International Prognostic Index）进行回顾性分析，我们假设HDT对诱导治疗后完全缓解的高风险患者有益。(C) 2000年由美国临床肿瘤学会出版。
Purpose: To present the final analysis, with a median follow-up of 8 years, of the LNH87-2 randomized study, which compares consolidative sequential chemotherapy (ifosfamide plus etoposide, asparaginase, and cytarabine) with high-dose therapy (HDT) using cyclophosphamide, carmustine, and etoposide (CBV regimen) followed by stem-cell transplantation in patients with aggressive non-Hodgkin's lymphoma in first complete remission after induction, focusing on high/intermediate- and high-risk patients identified by the age-adjusted international prognostic index.Patients and Methods: Among the 916 eligible patients, 451 presented with two (n = 318) or three (n = 133) risk factors. After reaching complete remission to induction therapy, 236 of these higher risk patients were assessable for the consolidation phase, with 125 patients in the HDT arm and 111 in the sequential chemotherapy arm.Results: Among these 451 higher risk patients, 277 (61%) achieved complete remission after induction treatment. In the population of 236 randomized patients, HDT wets superior to sequential chemotherapy, with I-year disease-free survival rates of 55% (95% confidence interval [CI], 46% to 64%) and 39% (95% CI, 30% to 48%), respectively (P = .02; relative risk, 1.56). The 8-year survival rate was significantly superior in the HDT arm (64%; 95% CI, 55% to 73%) compared with the sequential chemotherapy arm (49%; 95% CI, 39% to 59%) (P = .04: relative risk, 1.51).Conclusion.. On the basis of the final analysis of this prospectively treated series of patients, retrospectively analyzed on the basis of the International Prognostic Index, we hypothesize that HDT benefits patients at higher risk who achieve complete remission after induction treatment. (C) 2000 by American Society of Clinical Oncology.